Alaska Native Injury Atlas: An Updateanthctoday.org/epicenter/publications/InjuryAtlas/Alaska Native...

Alaska Native Injury Atlas:

An Update

October 2014

Alaska Native Tribal Health Consortium

Injury Prevention Program and Alaska Native Epidemiology Center

3900 Ambassador Drive, Suite 401

Anchorage AK 99508

Phone: 907-729-3513, 729-3799, 729-4567

Fax: 907-729-4569

E-mail: [email protected]

Website: http://anthctoday.org/community/prevention.html

Website: http://www.anthctoday.org/epicenter

Text in this document has been revised from the March 2014 edition.

This report is funded by the Alaska Native Tribal Health Consortium’s Injury Prevention Program and Behavioral Health Department’s Substance Abuse Prevention Initiative,

the Office of Minority Health (OMH) cooperative agreement 1AIAMP120014-01-00 and a cooperative agreement with the Indian Health Service U1B1IHS008-10-00.

Suggested citation:

Strayer, H, Craig, J, Asay, E, Haakenson, A, Provost, E. Alaska Native Injury Atlas: An Update, Revised. Anchorage, AK: Alaska Native Tribal Health Consortium Injury Prevention Program and Alaska Native Epidemiology Center. May, 2014.

Acknowledgements

We would like to thank the following State of Alaska programs for providing the data for this report: Alaska Bureau of Vital Statistics Alaska Department of Labor and Workforce Development Alaska Trauma Registry

Photo credits: Front and back cover photos courtesy of H. Strayer, K. Toth, D. Fancher, M. Clark and J. Wheeler. Regional Injury Profile photos courtesy of H. Strayer.

For additional information contact: Injury Prevention Program Alaska Native Tribal Health Consortium 3900 Ambassador Drive, Suite 401 Anchorage, AK 99508 Phone: (907) 729-3513, 729-3799 • Fax: (907) 729-3652 • [email protected]

This document was prepared by Hillary Strayer, MPH of the ANTHC Injury Prevention Program in collaboration with Jessica Craig, MPH, Elvin Asay, MS, Amie Haakenson, and Ellen Provost, DO, MPH of the ANTHC Alaska Native Epidemiology Center.

This report is available on the ANTHC Injury Prevention website at: http://www.anthc.org/chs/wp/injprev/injurydata.cfm

and on the ANTHC Alaska Native Epidemiology Center Website at: http://www.anthctoday.org/epicenter/publications

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ALASKA NATIVE INJURY ATLAS

Acknowledgements ................................................................................................................................... i

Table of Contents ................................................................................................................................. ii-iii

Introduction.............................................................................................................................................. 1

Executive Summary .................................................................................................................................. 2

Success Stories ...................................................................................................................................... 3-6

Injury Deaths

Leading Causes of Death ................................................................................................................. 7-9

Intentional Injuries ...................................................................................................................... 10-11

Unintentional Injuries ................................................................................................................. 12-13

Suicide ......................................................................................................................................... 14-15

Poisoning ..................................................................................................................................... 16-17

Drowning ..................................................................................................................................... 18-19

Motor Vehicle ............................................................................................................................. 20-21

Homicide ..................................................................................................................................... 22-23

Injury Hospitalizations

Injury Hospitalizations ..................................................................................................................... 25

Leading Causes of Injury Hospitalizations ................................................................................... 26-27

Intentional Injuries ...................................................................................................................... 28-29

Unintentional Injuries ................................................................................................................. 30-31

Falls ............................................................................................................................................. 32-33

Suicide Attempt or Self Harm ..................................................................................................... 34-35

Assault ......................................................................................................................................... 36-37

Motor Vehicle ............................................................................................................................. 38-39

All Terrain Vehicle ....................................................................................................................... 40-41

Snowmachine .............................................................................................................................. 42-43

Regional Injury Profiles

Injury Atlas Regions ......................................................................................................................... 45

Aleutians and Pribilofs Region .................................................................................................... 46-47

Anchorage and Matanuska-Susitna Region ................................................................................ 48-49

Arctic Slope Region ..................................................................................................................... 50-51

Bristol Bay Region ....................................................................................................................... 52-53

Copper River/Prince William Sound Region ............................................................................... 54-55

Interior Region ............................................................................................................................ 56-57

Table of Contents

Kenai Peninsula Region ............................................................................................................... 58-59

Kodiak Region ............................................................................................................................. 60-61

Northwest Arctic Region ............................................................................................................. 62-63

Norton Sound Region .................................................................................................................. 64-65

Southeast Region ........................................................................................................................ 66-67

Yukon-Kuskokwim Region ........................................................................................................... 68-69

Special Topics

I. Drug and Alcohol Poisonings ................................................................................................. 71-73

II. Alcohol or Drug Use-related Injuries ..................................................................................... 74-75

III. Access to Care ........................................................................................................................ 76-77

Appendixes

Appendix A. Description of Data Sources and Methods ............................................................ 79-83

Appendix B. Data Tables .......................................................................................................... 84-115

Appendix C. Injury Mechanisms with Corresponding ICD-9 and ICD-10 Codes ............................ 116

Appendix D. Access to Care Coding for Alaskan Communities .............................................. 117-122

Appendix E. Figures and Tables ............................................................................................. 123-127

Appendix F. Glossary of Terms ..................................................................................................... 128

Errata ............................................................................................................................................. 129

Table of Contents

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Notes:

EXECUTIVE SUMMARY 1


Introduction

“Alaska Natives are the healthiest people in the world.” Alaska Native Tribal Health Consortium’s Vision

This report provides an overview of injury among Alaska Native and American Indian people in Alaska (AN/AI). It describes the leading causes of injury deaths and injury hospitalizations statewide and within each region. It presents stories about successes in tribal injury prevention (IP), and describes some challenges to IP efforts in Alaska. Monitoring injuries over time can help to identify whether IP efforts are successful. In addition, this surveillance can identify disparities between groups which can help prioritize IP efforts. Information about injuries is important for focusing and evaluating IP efforts and activities. Intentional injuries are purposeful or deliberate harm caused by someone to themselves or another person, such as homicide, assault, suicide and suicide attempt. Unintentional injuries are those where harm was not caused on purpose or intended, such as poisoning, drowning, or motor vehicle crashes. Intentional and unintentional injuries combined were the leading cause of death for AN/AI during 2002-2011. Unintentional injuries alone were the third leading cause of death during this time period, preceded only by cancer and heart disease. Summaries of statewide data use the most recent decade of data available, 2002 through 2011, for both deaths and hospitalizations. This report also includes regional information, dividing the state into twelve regions. The regional summaries include data from 1992 through 2011. We recognize that data and the information gained from the interpretation of the data are only part of the decision-making process. Nevertheless, data can guide advocacy, policy making, strategic and program planning, and program evaluation. This document serves as a useful resource for those interested in Alaska Native injury-related issues and enables them to put data into action.

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2 EXECUTIVE SUMMARY


Executive Summary Injury Deaths 2002-2011

1,718 Alaska Native people died from injuries: 1,037 (60.3%) due to unintentional injuries, 603 (35.1%) due to intentional injuries, and 78 (4.5%) of undetermined intent. The three leading causes of injury death among Alaska Native people (AN/AI) were suicide, poisoning, and drowning. These three causes comprised 53.7% of all injury deaths.

Between 1992-1995 and 2008-2011, there was a significant decrease in the rates of death due to drowning (56.5%), motor vehicle crash (45.6%), homicide (37.9%), and suicide (14.4%) among AN/AI.

Between 1992-1995 and 2008-2011, there appeared to be a significant increase in the rates of death due to poisoning (360.5%), due in part to international changes in diagnostic coding.

AN/AI were 3.9 times as likely to die by drowning as non-Natives statewide.

AN/AI aged 20-29 years had the highest intentional injury death rate of any age group, with suicide as the most frequent cause. Those aged 70 and older had the highest unintentional injury death rate of any age group, with falls as the most frequent cause.

Injury Hospitalizations 2002-2011

There were 16,141 hospitalizations for injury among AN/AI: 10,955 (67.9%) due to unintentional injuries, 5,069 (31.4%) due to intentional injuries, and 117 (0.7%) of undetermined intent. The three leading causes of injury hospitalizations among AN/AI were falls, suicide attempts, and assaults. These three caused 60.4% of all injury hospitalizations.

Between 1992-1995 and 2008-2011, there was a significant decrease in the rates of assault (13.8%), motor vehicle-related (31.3%), and snowmachine-related (24.5%) injury hospitalizations among AN/AI.

Between 1992-1995 and 2008-2011, there was a significant increase in the rates of suicide attempt (73.7%) and all-terrain vehicle-related (13.8%) injury hospitalizations among AN/AI. One out of three (34.4%) of all-terrain vehicle-related hospitalizations were for youth aged 10-19.

AN/AI were 7.8 times as likely to be hospitalized for assault injuries and 6.6 times as likely to be hospitalized for snowmachine-related injuries as non-Natives statewide.

AN/AI aged 20-29 years had the highest intentional injury hospitalization rate of any age group, with suicide as the most frequent cause. Those aged 70 and older had the highest unintentional injury hospitalization rate of any age group, with falls as the most frequent cause.

Alcohol was documented as being associated with 63.2% of all intentional injury hospitalizations and 32.2% of all unintentional injury hospitalizations among AN/AI, based on blood alcohol and breathalyzer tests and other notes in the patient’s medical record.

Success Stories

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SUCCESS STORIES 3


Increasing Safety Gear Availability in Rural Communities

Accessing safety gear can be a challenge in rural and remote communities. Tribal injury prevention (IP) programs use innovative ways to increase access to safety gear for the communities they serve. Examples of the products provided include car seats, helmets, ice cleats, survival kits, carbon monoxide detectors, and float coats.

Most tribal IP programs have non-profit safety shops where people can purchase safety equipment. IP programs without shops make safety products available for purchase through their offices. They advertise to area residents by word of mouth, by circulating fliers, and by taking samples of safety gear (such as float coats, ice cleats, and helmets) on community visits. Most safety gear is sold at cost to hub community and outlying community residents.

Recently, several tribal IP programs acquired dealer status for selling snow-machine float coats and float pants. This status allows them to purchase gear at costs well below market price. This results in lower prices for the consumer, which may increase the purchase and use of safety equipment in the community. This flotation gear is stylish and warm enough that some residents choose to wear it in place of a parka. This regular use increases the potential safety benefits.

Some safety items may be provided at no cost or as incentives. In 2012, one tribal IP program provided local police with survival kits to be awarded to community members who wore helmets. Several regions give out free ice cleats every year to elders and/or pregnant women to help prevent falls on ice. Reflective tape is distributed by tribal IP programs in the fall, most often in partnership with schools, to improve pedestrian safety during the dark Alaskan winters.

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4 SUCCESS STORIES


Drowning Prevention Outreach Efforts In Rural Alaska

Drowning caused more deaths for Alaska Native people (AN/AI) than any other unintentional injury over the past 20 years. However, the drowning death rate for AN/AI has decreased by nearly half (18.0 in 1992-1995 to 11.8 in 2008-2011, per 100,000). This decrease has been attributed in part to several local efforts throughout the state. Two are highlighted below.

The White Float Coat Pilot Project

In northern communities in Alaska, bowhead whaling is an annual activity. There is a high risk of injury while whaling as it involves hunting a 25- to 70-ton animal using small boats such as umiaqs (traditional skin boat) or skiffs. Hunters use many safety measures during these hunts but historically did not use life jackets. They wear white during hunts as camouflage and out of respect for the whales and white float coats were not available. Supported by the Alaska Office of Boating Safety and the U.S. Coast Guard, the Alaska Native Tribal Health Consortium’s Injury Prevention (IP) Program engaged a manufacturer to make white float coats and led a pilot project to determine if whalers found it acceptable to wear white float coats during their hunts.

Eleven villages in Alaska engage in bowhead whaling. At the 2010 Alaska Eskimo Whaling Commission meeting, the project was endorsed by whaling captains who helped select the most comfortable jacket style for use during whaling activities. From 2010 to 2012, 24 captains representing these villages participated in the pilot test and their crews were outfitted with white float coats. Of those participating, four crews also received float pants to determine if they were also acceptable.

Pilot study results strongly favored the white flotation gear. Subsequently, demand has encouraged a commercial outfitter and two tribally-run safety shops to sell white flotation gear. Two crews that participated in the pilot project liked the white flotation gear so much that they led local efforts to get all whaling crews in their villages outfitted with it.

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SUCCESS STORIES 5


Drowning Prevention Outreach Efforts In Rural Alaska (continued)

Kids Don’t Float Program

The Kids Don’t Float program is a statewide drowning prevention effort supported by the State of Alaska. It has two components: 1) life jacket loaner board stations and 2) water safety training for youth.

The loaner board program started in Homer, Alaska in 1995 by a concerned community member with three stations that had youth life jackets hanging on boards that could be borrowed and returned. Because of its immediate success, the Alaska Department of Health and Social Services, Alaska Office of Boating Safety, U.S. Coast Guard District 17, and Safe Kids Alaska Coalition partnered to expand the program statewide. By 2013, there were 634 loaner boards in 216 communities around the state.

Tribal injury prevention (IP) programs are helping to promote and expand the Kids Don’t Float programs. The Alaska Native Tribal Health Consortium’s IP program and regional IP offices have reached out to communities to connect them with the loaner board program and establish new loaner board sites.

The State of Alaska also leads a Kids Don’t Float Peer Educator program which has a curriculum that provides simple, entertaining lessons that can be presented to grade school students and community members to increase their knowledge of water safety. Tribal IP staff have worked with the Alaska Office of Boating Safety staff to coordinate peer training for high school students who then provide lessons to grade school students. In addition, volunteers, including Coast Guard staff and auxiliary, lead this training in rural communities around the state.

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6 SUCCESS STORIES


Increasing Safe Gun Storage in Rural Alaska

In Alaska, particularly in rural areas, many households use guns for subsistence hunting. Although the number of unintentional injuries with guns is relatively small, intentional injuries with guns are more frequent. From 2002 to 2011, 349 Alaska Native people died from gun-related injuries: 277 (79.3%) were suicide deaths and only 10 (2.9%) were unintentional. Of the 338 gun-related injury hospitalizations over the same period, 143 (42%) were suicide attempt or self harm and 122 (36.1%) were unintentional.

Corporations’ IP programs worked with local housing authorities and the Alaska Native Tribal Health Consortium to install gun safes in 72 newly-built homes in those regions. Since then, the Bristol Bay Area Housing Authority modified home floor plans to allow the installation of fireproof gun safes. During 2011, five regional IP offices had gun safe projects, reaching approximately 300 families.

Since 2011, the Yukon-Kuskokwim Health Corporation (YKHC) safety shop, a non-profit store selling safety gear, has sold gun safes at cost and provided shipping to remote villages. This keeps the price the same for all residents. The YKHC safety shop has sold out of gun safes every year.

(1) Horn A, et al. Community based program to improve firearm storage practices in rural Alaska. Injury Prevention 2003;9:231–234.

(2) Grossman D, et al. Improving firearm storage in Alaska native villages: a randomized trial of household gun cabinets. Am J Public Health. 2012 ;102 Suppl 2:S291-7.

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Subsistence is essential to the Alaskan way of life. Tribal injury prevention (IP) programs promote safe storage and education to reduce gun-related injuries. Both a 2003 study by Horn et al. (1) and community feedback received by tribal IP staff determined that individual gun locks were ineffective because users found them inconvenient. Instead, gun safes or security cabinets were preferred because they could store multiple guns and other harmful items in the home such as medication and knives. A 2012 study by Grossman et al. showed that rural Alaska households had a substantial increase in safe gun storage after gun safes were installed. (2) Since the Grossman study, several tribal IP programs have increased the availability of gun safes. For example, in 2010, IP programs based at the Yukon-Kuskokwim and Bristol Bay Area Health

Injury Deaths

INJURY DEATHS 7


Figure 1. Leading Causes of Death by Age Group, Alaska Native People, 2001-2010 Data Source: National Center for Injury Prevention and Control, WISQARS Database.

Note: Colored blocks indicate causes of death related to injury.

† Causes resulting in fewer than 10 deaths are not reported

Rank

1 2 3 4 5

<1 year

Congenital

Anomalies

45

SIDS

44

Unintentional

Injury

38

Short

Gestation

15

Influenza and

Pneumonia

13

1-4 years

Unintentional

Injury

29

†

5-9 years

Unintentional

Injury

25

†

10-14 years

Unintentional

Injury

45

†

15-24 years

Suicide

216

Unintentional

Injury

29

Homicide

33

Heart

Disease

15

†

25-34 years

Unintentional

Injury

156

Suicide

104

Heart Disease

34

Homicide

27

Malignant

Neoplasms

25

35-44 years

Unintentional

Injury

200

Suicide

76

Malignant

Neoplasms

67

Heart

Disease

65

Liver

Disease

45

45-54 years

Malignant

Neoplasms

213

Unintentional

Injury

176

Heart

Disease

155

Liver

Disease

53

Suicide

45

55-64 years

Malignant

Neoplasms

337

Heart Disease

180

Unintentional

Injury

71

Chronic Lower

Resp. Disease

49

Liver

Disease

40

65+ years

Malignant

Neoplasms

905

Heart Disease

713

Chronic Lower

Resp. Disease

279

Cerebrovascular

253

Unintentional

Injury

123

All Ages

Malignant

Neoplasms

1,560

Heart

Disease

1,172

Unintentional

Injury

1,026

Suicide

469

Cerebrovascular

356

8 INJURY DEATHS


Figure 2. Leading Causes of Injury Death by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

§§ Categories with fewer than 5 deaths are not reported

‡ One case missing the region of occurrence

Aleutians

& Pribilofs

Anchorage

& MatSu

Arctic

Slope Bristol Bay

Copper

River/PWS Interior

Kenai

Peninsula Kodiak

Northwest

Arctic

Norton

Sound Southeast

Yukon-

Kuskokwim Total

1 §§ Poisoning

135

Suicide

28

Drowning

19

Suicide

6

Suicide

54

Suicide

13

Suicide

5

Suicide

48

Suicide

64

Suicide

28

Suicide

130

Suicide

478

2 Suicide

86

Off-Road Vehicle

9

Poisoning

14

Motor Vehicle

6

Poisoning

32

Motor Vehicle

13

§§ Drowning

17

Poisoning

14

Poisoning

28

Drowning

57

Poisoning

276

3 Motor

Vehicle 70

Drowning

8

Suicide

12

§§ Motor Vehicle

20

Poisoning

9

Off-Road Vehicle

11

Drowning

14

Drowning

17

Off-Road Vehicle

28

Drowning

168‡

4 Homicide

51

Motor Vehicle

5

Off-Road Vehicle

11

Excessive Cold 20

§§ Excessive Cold 10

Motor Vehicle

11

Homicide

12

Homicide

26

Motor Vehicle

158

5 Excessive

Cold 21

§§ Excessive Cold

7

Drowning

18

Poisoning

10

Homicide

11

Motor Vehicle

10

Poisoning

25

Homicide

125

Total 22 491 61 97 25 199 51 20 117 154 134 346 1,718‡

0 to 9

years

10 to 19

years

20 to 29

years

30 to 39

years

40 to 49

years

50 to 59

years

60 to 69

years

70 years

and older Total

1

Threats to

Breathing

33

Suicide

108

Suicide

195

Poisoning

72

Poisoning

79

Poisoning

46

Poisoning

13

Fall

12

Suicide

478

2

Drowning

19

Homicide

28

Poisoning

48

Suicide

71

Suicide

67

Suicide

25

Motor

Vehicle

12

Excessive

Cold

8

Poisoning

276

3

Motor

Vehicle

12

Motor

Vehicle

26

Drowning

37

Motor

Vehicle

34

Drowning

30

Motor

Vehicle

23

Drowning

9

Smoke, Fire

or Flames

6

Drowning

169

4

Homicide

7

Drowning

25

Off-Road

Vehicle

29

Drowning

31

Motor

Vehicle

21

Excessive

Cold

16

Suicide

8

Threats to

Breathing

6

Motor

Vehicle

158

5

Smoke, Fire

or Flames

6

Off-Road

Vehicle

24

Homicide

27

Homicide

27

Excessive

Cold

20

Drowning

14

Excessive

Cold

8

Poisoning

5

Homicide

125

Total 101 259 420 297 289 168 83 101 1,718

Figure 3. Leading Causes of Injury Death by Age, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

INJURY DEATHS 9


Figure 4. Leading Causes of Injury Death, Alaska Native Females, All Regions, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

§§ Categories with fewer than five deaths are not reported

0 to 9 years

10 to 19 years

20 to 29 years

30 to 39 years

40 to 49 years

50 to 59 years

60 to 69 years

70 years and older

Total

1 Threats to Breathing

13

Suicide

31

Suicide

38

Suicide

21

Poisoning

37

Poisoning

19

Poisoning

9

§§ Poisoning

129

2 Drowning

7

Motor Vehicle

14

Poisoning

17

Poisoning

39

Suicide

13

Motor Vehicle

6

§§ Suicide

111

3 §§ Drowning

7

Homicide

13

Motor Vehicle

9

Homicide

9

§§ Motor Vehicle

51

4 Homicide

7

Motor Vehicle

9

Homicide

5

Motor Vehicle

7

Homicide

44

5 Off-Road

Vehicle 7

§§ §§ Excessive Cold

7

Drowning

24

Total 40 77 89 95 89 46 23 42 501

Figure 5. Leading Causes of Injury Death Alaska Native Males, All Regions, 2002-2011 Data Source: Alaska Bureau of Vital Statistics


0 to 9 years

10 to 19 years

20 to 29 years

30 to 39 years

40 to 49 years

50 to 59 years

60 to 69 years

70 years and older

Total

1 Threats to Breathing

20

Suicide

77

Suicide

157

Suicide

50

Suicide

54

Poisoning

27

Motor Vehicle

10

Fall

8

Suicide

367

2 Drowning

12

Homicide

21

Drowning

36

Poisoning

33

Poisoning

42

Suicide

22

Excessive Cold

8

Off-Road Vehicle

5

Poisoning

147

3 Motor Vehicle

11

Drowning

18

Poisoning

31

Drowning

28

Drowning

27

Motor Vehicle

17

Drowning

7

§§ Drowning

145

4 §§ Off-Road

Vehicle 17

Off-Road Vehicle

26

Motor Vehicle

25

Motor Vehicle

14

Drowning

13

Off-Road Vehicle

6

Motor Vehicle

107

5 Motor

Vehicle 12

Motor Vehicle

16

Homicide

22

Excessive Cold 13

Excessive Cold 13

§§ Homicide

81

Total 61 182 331 202 200 122 60 59 1,217

10 INJURY DEATHS


Figure 6. Intentional Injury Death Rate †† by Region, Alaska Native People, 2002-2011

Intentional Injuries

Figure 7. Intentional Injury Death Rate †† by Gender, Race and Year, 1992-2011

Data Source: Alaska Bureau of Vital Statistics. Additional data available in tables B1-B4 in Appendix B.

†† Death rate per 100,000 age-adjusted to 2000 US standard population

* Regional rate is significantly different from the AN/AI statewide rate, p<0.05

** Rate is based on 10-19 deaths and should be interpreted with caution

¶ Rate not calculated due to small number of deaths (<10)


* Significantly different from the 1992-1995 rate, p<0.05

98.5

77.5*

30.6 23.9

39.932.2*

9.9 8.4

0

20

40

60

80

100

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

00,0

00

AK AN/AI Male AK AN/AI FemaleAK Non-Native Male AK Non-Native Female

INJURY DEATHS 11


Summary

During 2002-2011, 603 Alaska Native people died as a result of intentional injuries. This represented 35.1% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the intentional injury death rate decreased 21.1% among Alaska Native people (64.6 and 51.0 per 100,000, respectively, p<0.05).

Suicide was the mechanism for almost four out of every five intentional injury deaths (79.3%).

Alaska Native people aged 20-29 years had the highest intentional injury death rate of any age group (133.4 per 100,000). The rate for this age group was 2.6 times the age-adjusted rate for all ages (51.6 per 100,000, p<0.05).

Alaska Native males were 2.9 times more likely than Alaska Native females to die from intentional injuries (2002-2011, 77.0 and 27.0 per 100,000, respectively, p<0.05).

Alaska Native people statewide were 2.4 times more likely to die from intentional injuries than non-Natives (2002-2011, 51.6 and 21.4 per 100,000, respectively, p<0.05).

Figure 8. Intentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011

20.7%

79.3%

0% 20% 40% 60% 80% 100%

Homicide

Suicide

n=603

Intentional Injuries (continued)

12 INJURY DEATHS


Unintentional Injuries

Figure 9. Unintentional Injury Death Rate †† by Region, Alaska Native People, 2002-2011


Figure 10. Unintentional Injury Death Rate †† by Gender, Race and Year, 1992-2011






183.4

146.1*

69.772.7

90.2

64.9*

30.1 30.9

0

50

100

150

200

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

00,0

00


INJURY DEATHS 13


Summary

During 2002-2011, 1,037 Alaska Native people died as a result of unintentional injuries. This represented 60.3% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the unintentional injury death rate decreased 13.2% among Alaska Native people (126.1 and 109.5 per 100,000, respectively, p<0.05).

Poisoning was the mechanism for more than one out of every four (26.6%) unintentional injury deaths.

Alaska Native people aged 70 and older had the highest unintentional injury death rate of any age group (200.6 per 100,000). The rate for this age group was 1.9 times the age-adjusted rate for all ages (105.1 per 100,000, p<0.05).

Alaska Native males were 2.2 times more likely than Alaska Native females to die from unintentional injuries (2002-2011, 123.6 and 55.5 per 100,000, respectively, p<0.05).

Alaska Native people statewide were 2.1 times more likely to die from unintentional injuries than non-Natives (2002-2011, 105.1 and 49.5 per 100,000, respectively, p<0.05).

Figure 11. Unintentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011

3.1%

3.4%

4.7%

9.3%

9.4%

12.0%

15.2%

16.3%

26.6%

0% 10% 20% 30% 40% 50%

Smoke, fire or flames

Fall

Threats to breathing

Excessive cold

Off-road vehicle

Other or unspecified

Motor vehicle

Drowning

Poisoning

n=1,037

Unintentional Injuries (continued)

14 INJURY DEATHS






Suicide

Figure 12. Suicide Death Rate †† by Region, Alaska Native People, 2002-2011


Figure 13. Suicide Death Rate †† by Gender, Race and Year, 1992-2011



73.4

60.4*

19.3 18.4

30.7

27.2*

6.5 7.00

20

40

60

80

100

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

00,0

00


INJURY DEATHS 15


Summary

During 2002-2011, 478 Alaska Native people died as a result of suicide. This represented 27.8% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the suicide death rate decreased 14.4% among Alaska Native people (46.4 and 39.7 per 100,000, respectively, p<0.05).

Firearms were the mechanism for over half of the suicide deaths (58.0%).

Alaska Native people aged 20-29 years had the highest suicide death rate of any age group (117.1 per 100,000). The rate for this age group was 2.9 times the age-adjusted rate for all ages (40.3 per 100,000, p<0.05).

Alaska Native males were 3.3 times more likely than Alaska Native females to die from suicide (2002-2011, 63.1 and 19.4 per 100,000, respectively, p<0.05).

Alaska Native people statewide were 2.4 times more likely to die from suicide than non-Natives (2002-2011, 40.3 and 16.9 per 100,000, respectively, p<0.05).

Figure 14. Suicide Death by Type, Alaska Native People, All Ages, 2002-2011

2.5%

5.2%

34.3%

58.0%

0% 20% 40% 60% 80% 100%


Poisoning

Strangulation or suffocation

Firearm

n=478

Suicide (continued)

16 INJURY DEATHS


Poisoning





Figure 15. Poisoning Death Rate †† by Region, Alaska Native People, 2002-2011


Figure 16. Poisoning Death Rate †† by Gender, Race and Year, 1992-2011

9.5

43.3*

7.8

35.9*

4.6

17.7*

1.6

9.2*

0

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

00,0

00




INJURY DEATHS 17


Summary

During 2002-2011, 276 Alaska Native people died as a result of unintentional poisoning. This represented 16.1% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the unintentional poisoning death rate appears to have increased 360.5% among Alaska Native people (8.6 and. 39.6 per 100,000, respectively, p<0.05).

Illicit and prescription drugs were the mechanism for more than half of the unintentional poisoning deaths (51.4%).

Alaska Native people aged 40-49 years had the highest unintentional poisoning death rate of any age group (52.0 per 100,000). The rate for this age group was 1.9 times the age-adjusted rate for all ages (27.2 per 100,000, p<0.05).

Alaska Native males and Alaska Native females had similar unintentional poisoning death rates (2002-2011, 25.3 and 22.5 per 100,000, respectively).

Alaska Native people statewide were 2.4 times more likely to die from unintentional poisoning than non-Natives (2002-2011, 27.2 and 11.5 per 100,000, respectively, p<0.05).

Figure 17. Poisoning Death by Type, Alaska Native People, All Ages, 2002-2011

7.3%

41.3%

51.4%

0% 20% 40% 60% 80% 100%

Other or unspecified poisons

Alcohol

Illicit or prescription drugs

n=276

Poisoning (continued)

18 INJURY DEATHS


Drowning

Figure 18. Drowning Death Rate †† by Region, Alaska Native People, 2002-2011


Figure 19. Drowning Death Rate †† by Gender, Race and Year, 1992-2011







Note: No data for time period with less than 10 deaths.

49.4

22.2*

6.0

13.1

6.3*

2.3 1.2*0

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

00,0

00


INJURY DEATHS 19


Summary

During 2002-2011, 169 Alaska Native people died as a result of drowning. This represented 9.8% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the drowning death rate decreased 56.5% among Alaska Native people (27.6 and 12.0 per 100,000, respectively, p<0.05).

Either being in or falling into natural water were the circumstances for almost half of the drowning deaths (48.5%).

Alaska Native people aged 20-29 years had the highest drowning death rate of any age group (22.2 per 100,000). The rate for this age group was 1.5 times the age-adjusted rate for all ages (15.1 per 100,000, p<0.05).

Alaska Native males were 6.0 times more likely than Alaska Native females to die from drowning (2002-2011, 24.9 and 4.2 per 100,000, respectively, p<0.05).

Alaska Native people statewide were 3.9 times more likely to die from drowning than non-Natives (2002-2011, 15.1 and 3.9 per 100,000, respectively, p<0.05).

Figure 20. Drowning Death by Type, Alaska Native People, All Ages, 2002-2011

12.4%

24.3%

27.2%

36.1%

0% 10% 20% 30% 40% 50%

Fall into natural water, not from boat


Water transport, boating

While in natural water

n=169

Drowning (continued)

20 INJURY DEATHS


Motor Vehicle

Figure 21. Motor Vehicle Death Rate †† by Region, Alaska Native People, 2002-2011


Figure 22. Motor Vehicle Death Rate †† by Gender, Race and Year, 1992-2011







26.7

16.4*20.3

9.5*

25.2

11.7*12.9

5.6*

0

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

00,0

00

AK AN/AI Male AK AN/AI Female

AK Non-Native Male AK Non-Native Female

INJURY DEATHS 21


Summary

During 2002-2011, 158 Alaska Native people died as a result of motor vehicle crash. This represented 9.2% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the motor vehicle crash death rate decreased 45.6% among Alaska Native people (23.7 and 12.9 per 100,000, respectively, p<0.05).

Motor vehicle passengers and pedestrians represented more than nine out of every ten motor vehicle crash injury deaths (94.3%).

Alaska Native people aged 30-39 years had the highest motor vehicle crash death rate of any age group (23.8 per 100,000). The rate for this age group was 1.6 times greater than the age-adjusted rate for all ages (14.7 per 100,000, p<0.05).

Alaska Native males were 2.1 times more likely than Alaska Native females to die from a motor vehicle crash (2002-2011, 18.4 and 8.9 per 100,000, respectively, p<0.05).

Alaska Native people statewide were 1.3 times more likely to die from a motor vehicle crash than non-Natives (2002-2011, 14.7 and 11.7 per 100,000, respectively, p<0.05).

Figure 23. Motor Vehicle Death by Type, Alaska Native People, All Ages, 2002-2011

5.7%

36.7%

57.6%

0% 20% 40% 60% 80% 100%

Motorcyclist or Bicyclist

Pedestrian

Motor vehicle passenger

n=158

Motor Vehicle (continued)

22 INJURY DEATHS


Homicide

Figure 24. Homicide Death Rate †† by Region, Alaska Native People, 2002-2011


Figure 25. Homicide Death Rate †† by Gender, Race and Year, 1992-2011

25.1

17.1*11.3

5.5*9.25.0*

3.4 1.4*0

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er1

00,0

00









INJURY DEATHS 23


Summary

During 2002-2011, 125 Alaska Native people died as a result of homicide. This represented 7.3% of all injury deaths (1,718).

Between 1992-1995 and 2008-2011, the homicide death rate decreased 37.9% among Alaska Native people (18.2 and 11.3 per 100,000, respectively, p<0.05).

Firearms were the mechanism for almost half of the homicide deaths (49.6%).

Alaska Native people aged 30-39 years had the highest homicide death rate of any age group (18.9 per 100,000). The rate for this age group was 1.7 times the age-adjusted rate for all ages (11.2 per 100,000, p<0.05).

Alaska Native males were 1.8 times more likely than Alaska Native females to die from homicide (2002-2011, 13.9 and 7.7 per 100,000, respectively, p<0.05).

Alaska Native people statewide were 2.5 times more likely to die from homicide than non-Natives (2002-2011, 11.2 and 4.5 per 100,000, respectively, p<0.05).

Figure 26. Homicide Death by Type, Alaska Native People, All Ages, 2002-2011

4.8%

14.4%

31.2%

49.6%

0% 10% 20% 30% 40% 50%

Strangulation or suffocation

Sharp object


Firearm

n=125

Homicide (continued)

24 INJURY DEATHS


Notes

INJURY HOSPITALIZATIONS 25


Injury hospitalizations are collected in the Alaska Trauma Registry (ATR). The cases reported in the ATR include patients with injuries admitted to an Alaska hospital, held for observation, transferred to another acute care hospital, or declared dead in the emergency department. The ATR includes other fatal cases as well: some patients admitted for injury might die during their stay at the hospital, from the injury that was the cause of the admission, or some other cause that developed during their stay (e.g. pneumonia). If the patient admitted to the hospital died there from some other cause, the injury would not be listed as the cause of death in the fatality database maintained by Alaska Bureau of Vital Statistics. Injuries in the ATR that were categorized as fatal were retained in all of the analyses of so no injury cases would be lost.

Unlike data for deaths, comprehensive data for all causes of hospitalization in Alaska were not available from either state or national sources. Because of this, no frequency or rate comparison can be provided between injuries and other causes of hospitalization (acute illness, chronic disease).

Ph

oto

by

H. S

tray

er


26 INJURY HOSPITALIZATIONS


Figure 27. Leading Causes of Injury Hospitalization by Region, All Alaska Native People, 2002-2011 * Data Source: Alaska Trauma Registry

‡ 152 cases missing the region of occurrence: 37 Falls, 15 Suicide Attempts, 19 Assaults, 18 Motor Vehicle, 7 ATV, 9 Snowmachine, and 47 Other

Aleutians

& Pribilofs

Anchorage

& MatSu

Arctic

Slope

Bristol

Bay

Copper

River/PWS Interior

Kenai

Peninsula Kodiak

Northwest

Arctic

Norton

Sound Southeast

Yukon-

Kuskokwim Total

1 Falls

61

Falls

1,328

Falls

234

Falls

223

Falls

68

Falls

534

Falls

166

Falls

68

Suicide Attempts

301

Suicide Attempts

514

Falls

771

Falls

679

Falls‡

4,801

2

Assault

17

Assault

624

Suicide Attempts

109

ATV

98

Motor Vehicle

38

Suicide Attempts

355

Motor Vehicle

92

Suicide Attempts

35

Falls

278

Falls

348

Suicide Attempts

335

Suicide Attempts

647

Suicide Attempts‡

3,021

3 ATV

13

Motor Vehicle

615

Assault

80

Suicide Attempts

88

Suicide Attempts

19

Assault

264

Suicide Attempts

63

Motor Vehicle

23

Assault

208

Assault

128

Assault

201

Assault

357

Assault‡

2,045

4 Suicide

Attempts 7

Suicide Attempts

539

ATV

72

Assault

88

Assault

19

Motor Vehicle

180

Assault

31

ATV

16

Snow-machine

136

ATV

111

Motor Vehicle

169

Snow-machine

259

Motor Vehicle‡

1,376

5 Motor Vehicle

7

Other Vehicle

162

Snow-machine

63

Snow-machine

53

Snow-machine

9

Snow-machine

98

ATV

17

Other Vehicle

13

ATV

102

Snow-machine

76

Other Vehicle

79

ATV

193

ATV

774

6 Other

Vehicle 6

Cut

93

Motor Vehicle

42

Motor Vehicle

46

Other Vehicle

8

ATV

72

Struck by Object

16

Assault

12

Other Vehicle

40

Motor Vehicle

56

Poisoning

50

Cut

126

Snow-machine‡

749

Total 133 3,913 724 810 203 1,895 479 210 1,263 1,513 1,904 2,942 16,141‡

Figure 28. Leading Causes of Injury Hospitalization by Age Group, All Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry

0 to 9

years

10 to 19

years

20 to 29

years

30 to 39

years

40 to 49

years

50 to 59

years

60 to 69

years

70 years

and older Total

1

Falls

541

Suicide

Attempts

914

Suicide

Attempts

997

Suicide

Attempts

495

Falls

694

Falls

697

Falls

568

Falls

1013

Falls‡

4,807

2

Submersion or

Suffocation

109

Falls

417

Assault

709

Falls

430

Assault

420

Assault

176

Motor

Vehicle

51

Motor

Vehicle

52

Suicide

Attempts

3,022

3

Poisoning

109

Motor

Vehicle

314

Falls

447

Assault

422

Suicide

Attempts

404

Suicide

Attempts

155

Suicide

Attempts

35

ATV

38

Assault

2,047

4

Other

Vehicle

97

ATV

267

Motor

Vehicle

344

Motor

Vehicle

194

Motor

Vehicle

191

Motor

Vehicle

136

Snowmachine

31

Snowmachine

24

Motor

Vehicle

1,375

5

Motor

Vehicle

96

Assault

230

Snowmachine

219

Snowmachine

110

Snowmachine

91

Other

Vehicle

46

Assault

30

Assault

19

ATV

774

6

ATV

75

Poisoning

211

ATV

169

ATV

99

Other

Vehicle

88

Snowmachine

45

Natural or

Environmental

29

Struck by

Object

18

Snowmachine

749

Total 1,422 3,131 3,430 2,158 2,355 1,520 865 1,257 16,141‡

‡ 3 cases are missing age group: 2 Falls and 1 Other



Figure 29. Leading Causes of Injury Hospitalization, Alaska Native Males, All Regions, 2002-2011 Data Source: Alaska Trauma Registry

Figure 30. Leading Causes of Injury Hospitalization, Alaska Native Females, All Regions, 2002-2011 Data Source: Alaska Trauma Registry

0 to 9

years

10 to 19

years

20 to 29

years

30 to 39

years

40 to 49

years

50 to 59

years

60 to 69

years

70 years

and older Total

1 Falls

246

Suicide Attempts

638

Suicide Attempts

597

Suicide Attempts

305

Falls

297

Falls

385

Falls

373

Falls

716

Falls

2,516

2 Submersion or

Suffocation 49

Falls

137

Assault

190

Falls

189

Suicide Attempts

260

Suicide Attempts

102

Suicide Attempts

27

Motor Vehicle

33

Suicide Attempts

1,937

3 Poisoning

48

Motor Vehicle

128

Falls

173

Assault

115

Assault

115

Motor Vehicle

63

Motor Vehicle

18

ATV

20

Motor Vehicle

603

4 Other

Vehicle 35

ATV

123

Motor Vehicle

153

Motor Vehicle

90

Motor Vehicle

86

Assault

41

Snowmachine

14

Assault

8

Assault

549

5 Motor Vehicle

32

Poisoning

117

ATV

48

ATV

27

ATV

28

ATV

16

Assault

10

Struck by Object

7

ATV

297

Total 588 1,379 1,306 862 926 697 480 827 7,066‡

0 to 9

years

10 to 19

years

20 to 29

years

30 to 39

years

40 to 49

years

50 to 59

years

60 to 69

years

70 years

and older Total

1

Falls

295

Falls

280

Assault

519

Assault

307

Falls

397

Falls

312

Falls

195

Falls

296

Falls

2,290

2

Motor

Vehicle

63

Suicide

Attempts

276

Suicide

Attempts

399

Falls

241

Assault

305

Assault

135

Motor

Vehicle

33

Motor

Vehicle

19

Assault

1,498

3

Poisoning

61

Motor

Vehicle

186

Falls

274

Suicide

Attempts

190

Suicide

Attempts

144

Motor

Vehicle

73

Natural or

Environmental

26

Snowmachine

19

Suicide

Attempts

1,084

4

Submersion or

Suffocation

60

Assault

177

Motor

Vehicle

191

Motor

Vehicle

103

Motor

Vehicle

105

Suicide

Attempts

53

Assault

20

ATV

18

Motor

Vehicle

773

5

Other

Vehicle

60

Snowmachine

148

Snowmachine

178

Snowmachine

85

Other

Vehicle

73

Other

Vehicle

39

Snowmachine

17

Assault

11

Snowmachine

569

Struck by

Object

11

Natural or

Environmental

11

Total 833 1,752 2,122 1,295 1,429 823 385 429 9,070‡

‡ 2 cases missing age group: 1 Falls, 1 Other. 5 cases missing gender

‡ 1 case missing age group: 1 Falls. 5 cases missing gender




Figure 31. Intentional Injury Hospitalization Rate§ by Region, Alaska Native People, 2002-2011

Data Source: Alaska Trauma Registry. Additional data available in tables B29-B32 in Appendix B.

Figure 32. Intentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011

§ Hospitalization rate per 10,000 age-adjusted to 2000 US standard population




41.4 42.4

30.837.9*

7.7 6.4*5.4

6.5*

0

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Summary

During 2002-2011, there were 5,069 hospitalizations for intentional injuries among Alaska Native people. This represented 31.4% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the intentional injury hospitalization rate increased 10.9% (36.2 and 40.1 per 10,000, respectively, p<0.05).

Attempted suicide was the mechanism for almost three out of every five intentional injury hospitalizations (59.6%).

Alaska Native people aged 20-29 years had the highest intentional injury hospitalization rate of any age group (102.4 per 10,000). The rate for this age group was 2.4 times the age-adjusted rate for all ages (43.2 per 10,000, p<0.05).

Alaska Native males and Alaska Native females had similar rates of hospitalization from intentional injuries (2002-2011, 43.4 and 4.4 per 10,000, respectively).

Alaska Native people were 6.1 times more likely to be hospitalized for an intentional injury than non-Natives statewide (2002-2011, 43.2 and 7.1 per 10,000, respectively, p<0.05).

Almost two out of three (63.2%) of intentional injury hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 33. Intentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

40.4%

59.6%

0% 20% 40% 60% 80% 100%

Assault

Suicide Attempt

n = 5,069

Intentional Injuries (continued)




Figure 34. Unintentional Hospitalization Rate§ by Region, Alaska Native People, 2002-2011


Figure 35. Unintentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011





131.8

106.9*97.0 90.4*

68.750.4*

49.3 43.0*

0

50

100

150

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Summary

During 2002-2011, there were 10,955 hospitalizations for unintentional injuries among Alaska Native people. This represented 67.9% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the unintentional injury hospitalization rate decreased 13.2% (115.3 and 100.1 per 10,000, respectively, p<0.05).

Falls were the mechanism for more than two out of every five unintentional injury hospitalizations (43.9%).

Alaska Native people aged 70 years and older had the highest unintentional injury hospitalization rate of any age group (272.6 per 10,000). The rate for this age group was 2.5 times the age-adjusted rate for all ages (109.2 per 10,000, p<0.05).

Alaska Native males were 1.4 times more likely to be hospitalized for unintentional injuries than Alaska Native females (2002-2011, 110.3 and 79.1 per 10,000, respectively, p<0.05).

Alaska Native people were 2.1 times more likely to be hospitalized for an unintentional injury than non-Natives statewide (2002-2011, 109.2 and 51.6 per 10,000, respectively, p<0.05).

Almost one out of three (32.5%) unintentional injury hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 36. Unintentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

3.4%

3.6%

5.0%

6.8%

7.1%

12.6%

17.6%

43.9%

0% 10% 20% 30% 40% 50%

Poisoning

Cut

Other Vehicle

Snowmachine

ATV

Motor Vehicle

Other Incidents

Falls

n = 10,955

Unintentional Injuries (continued)



Falls

Figure 37. Falls Hospitalization Rate§ by Region, Alaska Native People, 2002-2011


Figure 38. Falls Hospitalization Rate§ by Gender, Race and Year, 1992-2011





48.1 46.0

59.462.0

29.0

24.7*30.130.3

0

20

40

60

80

100

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Summary

Falls were the leading cause of injury hospitalizations among Alaska Native people. During 2002-2011, there were 4,809 hospitalizations for fall injuries among Alaska Native people. This represented 29.8% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the fall-related hospitalization rate did not significantly change (54.7 and 55.3 per 10,000, respectively).

Slipping, tripping or stumbling on the same level were the mechanism for more than two out of every five fall injury hospitalizations (44.3%).

Alaska Native people aged 70 years and older had the highest falls injury hospitalization rate of any age group (225.6 per 10,000). The rate for this age group was 4.0 times the age-adjusted rate for all ages (56.8 per 10,000, p<0.05).

Alaska Native females were 1.1 times more likely than Alaska Native males to be hospitalized for fall injuries (2002-2011, 43.9 and 39.4 per 10,000, respectively, p<0.05).

Alaska Native people were 1.9 times more likely to be hospitalized for a fall injury than non-Natives statewide (2002-2011, 56.8 and 29.1 per 10,000, respectively, p<0.05).

Almost one out of three (29.4%) fall-related injury hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 39. Falls Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

2.1%

2.3%

4.3%

11.1%

16.2%

19.7%

44.3%

0% 10% 20% 30% 40% 50%

Ladders or scaffolding

Same level,collision or shoving by person

Out of building or other structure

Stairs or steps

From one level to another


Same level, slipping or stumbling

n = 4,809

Falls (continued)



Suicide Attempt or Self Harm

Figure 40. Suicide Attempt or Self Harm Hospitalization Rate§ by Region, Alaska Native People, 2002-2010


Figure 41. Suicide Attempt or Self Harm Hospitalization Rate§ by Gender, Race and Year, 1992-2010


¶ Rate not calculated due to small number of hospitalizations (<20)




12.418.4*

18.3

35.0*

2.8 4.0*4.5 6.9*

0

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2010

Rat

e p

er 1

0,00

0





Summary

Complete data on poisoning-related suicide attempts were not available in 2011, so suicide attempt and self harm data are analyzed through 2010.

During 2002-2010, there were 2,901 hospitalizations for suicide attempt and self-harm among Alaska Native people. This represented 18.0% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2010, the suicide attempt and self-harm hospitalization rate increased 73.7% (15.3 and 26.6 per 10,000, respectively, p<0.05).

Poisoning was the mechanism for almost three out of every four suicide attempt and self harm hospitalizations (76.0%).

Alaska Native people aged 20-29 years had the highest suicide attempt and self harm hospitalization rate of any age group (66.5 per 10,000). The rate for this age group was 2.5 times the age-adjusted rate for all ages (26.8 per 10,000, p<0.05).

Alaska Native females were 1.8 times more likely than Alaska Native males to be hospitalized for suicide attempts and self harm (2002-2010, 34.4 and 19.1 per 10,000, respectively, p<0.05).

Alaska Native people were 5.1 times more likely to be hospitalized for a suicide attempts and self harm than non-Natives statewide (2002-2010, 26.8 and 5.3 per 10,000, respectively, p<0.05).

Almost three out of five (57.5%) suicide attempt and self harm hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 42. Suicide Attempt or Self Harm Hospitalization by Type, Alaska Native People, All Ages, 2002-2010

2.4%

4.3%

4.5%

12.8%

76.0%

0% 20% 40% 60% 80% 100%


Hanging, strangulation or suffocation

Firearms, air guns or explosives

Cutting or piercing instrument

Poisoning

n= 2,901

Suicide Attempt or Self Harm (continued)



Assault

Figure 43. Assault Hospitalization Rate§ by Region, Alaska Native People, 2002-2011


Figure 44. Assault Hospitalization Rate§ by Gender, Race and Year, 1992-2011






29.126.6*

12.5 9.3*

4.8 3.1*0.9 0.80

10

20

30

40

50

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Summary

During 2002-2011, there were 2,047 hospitalizations for assault injuries among Alaska Native people. This represented 12.7% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the assault injury hospitalization rate decreased 13.8% (20.9 and 18.0 per 10,000, respectively, p<0.05).

Fights and brawls were the mechanism for more than half of assault injury hospitalizations (54.8%).

Alaska Native people aged 20-29 years had the highest assault injury hospitalization rate of any age group (42.6 per 10,000). The rate for this age group was 2.3 times the age-adjusted rate for all ages (18.4 per 10,000, p<0.05).

Alaska Native males were 2.7 times more likely than Alaska Native females to be hospitalized for assault injuries (2002-2011, 25.8 and 9.6 per 10,000, respectively, p<0.05).

Alaska Native people were 7.8 times more likely to be hospitalized for an assault injury than non-Natives statewide (2002-2011, 18.4 and 2.2 per 10,000, respectively, p<0.05).

Almost three out of four (71.4%) assault injury hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 45. Assault Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

3.6%

3.6%

4.5%

8.9%

11.5%

13.1%

54.8%

0% 20% 40% 60% 80% 100%

Firearms or explosives

Human bite

Child or adult abuse

Struck by blunt or thrown object

Cutting or piercing instrument


Fight or brawl

n = 2,047

Assault (continued)



Motor Vehicle

Figure 46. Motor Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011


Figure 47. Motor Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011






16.7

11.0*12.9

9.1*

12.7

7.9*9.1

4.8*

0

5

10

15

20

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Summary

During 2002-2011, there were 1,378 hospitalizations for motor vehicle-related injuries among Alaska Native people. This represented 8.5% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the motor vehicle-related injury hospitalization rate decreased 31.3% (14.8 and 10.1 per 10,000, respectively, p<0.05).

Collisions with another vehicle was the circumstance for more than one out of every four motor vehicle-related injury hospitalizations (27.7%).

Alaska Native people aged 20-29 years had the highest motor vehicle-related injury hospitalization rate of any age group (20.7 per 10,000). The rate for this age group was 1.7 times the age-adjusted rate for all ages (12.1 per 10,000, p<0.05).

Alaska Native males were 1.3 times more likely than Alaska Native females to be hospitalized for motor vehicle-related injuries (2002-2011, 13.3 and 10.5 per 10,000, respectively, p<0.05).

Alaska Native people were 1.6 times more likely to be hospitalized for a motor vehicle-related injury than non-Natives statewide (2002-2011, 12.1 and 7.8 per 10,000, respectively, p<0.05).

Almost one out of two (45.4%) motor vehicle-related injury hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 48. Motor Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

4.3%

7.2%

9.8%

24.7%

26.3%

27.7%

0% 10% 20% 30% 40% 50%

While boarding or alighting


Motorcycle

Crash without collision

Collision with pedestrian or bicyclist

Collision with other vehicle

n = 1,378

Motor Vehicle (continued)



All-Terrain Vehicle

Figure 49. All-Terrain Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011


Figure 50. All-Terrain Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011






7.3 7.5

3.3

4.3*

1.32.0*

0.50.9*

0

2

4

6

8

10

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Summary

During 2002-2011, there were 774 hospitalizations for ATV-related injuries among Alaska Native people. This represented 4.8% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the all-terrain vehicle (ATV)-related hospitalization rate increased 13.8% (5.2 and 5.9 per 10,000, respectively, p<0.05).

ATV drivers represented nearly two out of every three ATV-related hospitalizations (61.1%).

More than one-third (34.4%) of all Alaska Native ATV-related hospitalizations were among youth aged 10-19. Alaska Native people aged 10-19 years had the highest ATV-related hospitalization rate of any age groups (11.0 per 10,000). The rate for this age group was 1.7 times the age-adjusted rate for all ages (6.5 per 10,000, p<0.05).

Alaska Native males were 1.6 times more likely than Alaska Native females to be hospitalized for ATV-related injuries (2002-2011, 8.2 and 5.2 per 10,000, respectively, p<0.05).

Alaska Native people were 4.5 times more likely to be hospitalized for an (ATV)-related injury than non-Natives statewide (2002-2011, 6.5 and 1.4 per 10,000, respectively, p<0.05).

One out of three (33.6%) ATV-related injury hospitalizations among Alaska Native people were reported as alcohol-related.

Figure 51. All-Terrain Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

6.5%

7.5%

24.9%

61.1%

0% 20% 40% 60% 80% 100%

Pedestrian


ATV Passenger

ATV Driver

n = 774

All-Terrain Vehicle (continued)



Snowmachine

Figure 52. Snowmachine Hospitalization Rate§ by Region, Alaska Native People, 2002-2011


Figure 53. Snowmachine Hospitalization Rate§ by Gender, Race and Year, 1992-2011






11.1

9.0*

3.8 2.4*1.5 1.2*0.3 0.40

5

10

15

20

1992-1995 1996-1999 2000-2003 2004-2007 2008-2011

Rat

e p

er 1

0,00

0





Figure 54. Snowmachine Hospitalization by Type, Alaska Native People, All Ages, 2002-2011

Summary

During 2002-2011, there were 749 hospitalizations for snowmachine-related injuries among Alaska Native people. This represented 4.6% of all injury hospitalizations (16,141).

Between 1992-1995 and 2008-2011, the snowmachine-related hospitalization rate decreased 24.5% (7.5 and 5.6 per 10,000, respectively, p<0.05).

Drivers represented nearly three out of every four snowmachine-related hospitalizations (72.2%).

Alaska Native people aged 20-29 years had the highest snowmachine-related hospitalization rate of any age group (13.2 per 10,000). The rate for this age group was 2.0 times the age-adjusted rate for all ages (6.5 per 10,000, p<0.05).

Alaska Native males were 3.1 times more likely than Alaska Native females to be hospitalized for snowmachine-related injuries (2002-2011, 9.8 and 3.1 per 10,000, respectively, p<0.05).

Alaska Native people were 6.6 times more likely to be hospitalized for a snowmachine-related injury than non-Natives statewide (2002-2011, 6.5 and 1.0 per 10,000, respectively, p<0.05).

Two out of every five (40.2%) snowmachine-related hospitalizations among Alaska Native people were reported as alcohol-related.

5.5%

6.9%

15.4%

72.2%

0% 20% 40% 60% 80% 100%

Pedestrian


Snowmachine Passenger

Snowmachine Driver

n = 749

Snowmachine (continued)



Notes

Regional Injury Profiles

REGIONAL INJURY PROFILES 45


Table 1. Regions by Tribal Health Organizations and Census Areas

Injury Atlas Regions In order to have sufficient numbers of injuries to allow rate calculations tribal health organization (THO) service areas were combined into larger regions. Every effort was made to align regions with THO service areas. But because of limitations on what population data were available, a few communities were moved from the region that matches their THO region to their census area/borough region. The villages moved from their THOs are listed as exceptions below.

Regions used in

this report Census Area/Boroughs

included in Region THOs in Region Exceptions

Aleutians and

Pribilofs Aleutians East Borough,

Aleutians West Borough Aleutian Pribilof Islands Assoc., St. George

Traditional Council, Eastern Aleutian Tribes

Anchorage/

Matanuska-Susitna Anchorage Municipality,

Matanuska-Susitna Borough Southcentral Foundation, Eklutna Native

Village, Chickaloon Village, Knik Tribe

Arctic Slope North Slope Borough Artic Slope Native Assoc., North Slope

Borough, Ukpeagvik Inupiat Corp.

Bristol Bay Dillingham, Lake and

Peninsula Borough, Bristol

Bay Borough

Bristol Bay Area Health Corp. Goodnews Bay and Platinum

were included in Yukon-

Kuskokwim

Copper River/Prince

William Sound Valdez/Cordova Chugachmiut (part), Chitna Traditional

Village Council, Copper River Native

Assoc., Mt. Sanford Tribal Consortium,

Valdez Native Tribe

Seward, Port Graham, and

Nanwalek, were included in

Kenai Peninsula; Cantwell was

included in Interior

Interior Denali Borough, Fairbanks

North Star Borough, SE

Fairbanks, Yukon-Koyukuk

Tanana Chiefs Conference, Council of

Athabascan Tribal Governments, Fairbanks

Native Assoc., Tanana Tribal Council

Anaktuvak Pass was included

in Arctic Slope

Kenai Peninsula Kenai Peninsula Borough Chugachmiut (part), Kenaitze Indian Tribe,

Ninilchik Traditional Council, Seldovia

Village Tribe, Tyonek Native Village

Chenega Bay, Tatitlek, Valdez

and Cordova were included in

Copper R/Prince William

Sound

Kodiak Kodiak Island Borough Kodiak Area Native Assoc., Karluk Tribal

Council

Northwest Arctic Northwest Arctic Borough Maniilaq Point Hope was included in

Arctic Slope

Norton Sound Nome Norton Sound Health Corp., Native Village

of Diomede

Southeast Hoonah-Angoon, Prince of

Wales/Hyder, Petersburg;

Boroughs of Haines, Juneau,

Ketchikan, Skagway, Sitka,

Wrangell, and Yakutat

Southeast Alaska Regional Health

Consortium, Hoonah Indian Association,

Ketchikan Indian Association, Metlakatla

Indian Community, Yakutat Tlingit Tribe

Yukon-Kuskokwim Bethel, Wade Hampton Akiachak Native Village, Native Village of

Kwinhagak, Yukon-Kuskokwim Health

Corporation

Anvik, Grayling, Holy Cross,

and Shageluk were included in

Interior

46 REGIONAL INJURY PROFILES


Aleutians and Pribilofs Region


Summary

Falls (46.1%), assaults (9.2%), and all-terrain vehicle incidents (7.5%) were the three leading causes of injury hospitalizations during 1992-2011 among Aleutians and Pribilofs (Aleut Prib) Alaska Native people, and represented almost two thirds of all Aleut Prib injury hospitalizations (62.7%).

The intentional injury hospitalization rate for Aleut Prib Alaska Native people was significantly lower (rate ratio = 0.2) than that for Alaska Native people statewide (8.9 and 42.4 per 10,000, respectively, p<0.05).

Table 2. Leading Causes of Aleutians and Pribilofs Injury Hospitalizations, 1992-2011 Data Source: Alaska Trauma Registry

1 Rate Ratio indicates if the injury risk is greater (>1) or less (<1) than the risk for AN/AI statewide



* Statistically significant difference between rates, p<0.05

n/a Not applicable


Mechanism of Injury n % Rate §Aleut Prib AN/AI

vs. Alaska AN/AI 1

Assault 27 9.2% 6.8 0.3*

Suicide Attempt or Self Harm 9 3.1% ¶ n/a

Total Intentional Injuries 36 12.2% 8.9 0.2*

Falls 136 46.1% 42.3 0.7*

All-Terrain Vehicle 22 7.5% 5.5 0.9

Other Vehicle 21 7.1% 4.9 1.0

Motor Vehicle 20 6.8% 4.6 0.3*

Cut 13 4.4% ¶ n/a

Struck By Person/Object 6 2.0% ¶ n/a

Sports 6 2.0% ¶ n/a

Other 35 11.9% n/a n/a

Total Unintentional Injuries 258 87.5% 71.5 0.6*

Undetermined Intent §§ 0.3% n/a n/a

Total Injuries 295 100.0% 80.7 0.5*



Table 3. Leading Causes of Aleutians and Pribilofs Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Aleutians and Pribilofs Region

Injury Deaths




n/a Not applicable


**Rate is based on 10-19 deaths and should be interpreted with caution


Summary

Suicide (17.6%), drowning (15.7%), and unintentional poisoning (13.7%) were the three leading causes of injury death during 1992-2011 among Aleutians and Pribilofs (Aleut Prib) Alaska Native people, and represented about half of all Aleut Prib injury deaths (47.1%).

The intentional injury death rate for Aleut Prib Alaska Native people was significantly lower (rate ratio = 0.6) than that for Alaska Native people statewide (32.8 and 55.2 per 100,000, respectively, p<0.05).

Mechanism of Injury n % Rate ††

Aleut Prib AN/AI

vs. Alaska AN/AI 1

Suicide 9 17.6% ¶ n/a

Homicide 5 9.8% ¶ n/a

Total Intentional Injuries 14 27.4% 32.8** 0.6*

Drowning 8 15.7% ¶ n/a

Poisoning 7 13.7% ¶ n/a

Motor Vehicle 6 11.8% ¶ n/a


Total Unintentional Injuries 36 70.6% 106.9 1.0


Total 51 100.0% 142.0 0.8*



Anchorage and Matanuska-Susitna Region


Summary

Falls (31.2%), motor vehicle incidents (17.5%), and assaults (16.9%) were the three leading causes of injury hospitalizations during 1992-2011 among Anchorage and Matanuska-Susitna (Anc/MatSu) Alaska Native people, and represented about two thirds of all Anc/MatSu injury hospitalizations (65.6%).

The motor vehicle injury hospitalization rate for Anc/MatSu Alaska Native people was significantly higher (rate ratio = 1.8) than that for Alaska Native people statewide (24.0 and 13.7 per 10,000, respectively, p<0.05).

Table 4. Leading Causes of Anchorage and Matanuska-Susitna Injury Hospitalizations, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Anc/MatSu AN/AI

vs. Alaska AN/AI 1

Assault 1,209 16.9% 22.4 1.1*

Suicide Attempt or Self Harm 951 13.3% 16.4 0.7*

Total Intentional Injuries 2,160 30.2% 38.9 0.9*

Falls 2,230 31.2% 60.5 1.1*

Motor Vehicle 1,252 17.5% 24.0 1.8*


Cut 186 2.6% 3.3 0.8*

Natural and Environmental 135 1.9% 2.6 0.8*

Poisoning 128 1.8% 1.9 0.9

Struck By Person/Object 118 1.7% 2.1 0.6*


Total Unintentional Injuries 4,921 68.8% 109.4 1.0*

Undetermined Intent 69 1.0% n/a n/a

Total Injuries 7,150 100.0% 149.5 0.9*



Table 5. Leading Causes of Anchorage and Matanuska-Susitna Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Anchorage and Matanuska-Susitna Region

Injury Deaths




n/a Not applicable

Summary

Unintentional poisoning (21.0%), suicide (17.8%), and motor vehicle incidents (17.1%) were the three leading causes of injury death during 1992-2011 among Anchorage and Matanuska-Susitna (Anc/MatSu) Alaska Native people, and represented more than half of all Anc/MatSu injury deaths (55.8%).

The death rates due to threats to breathing/falls for Anc/MatSu Alaska Native people were significantly higher (rate ratio = 2.0) than that for Alaska Native people statewide (11.0/9.5 and 5.5/4.8 per 100,000, respectively, p<0.05).


Anc/MatSu AN/AI

vs. Alaska AN/AI 1

Suicide 156 17.8% 27.1 0.7*

Homicide 115 13.1% 21.3 1.5*


Poisoning 184 21.0% 37.8 1.8*

Motor Vehicle 150 17.1% 33.0 1.9*

Threats To Breathing 41 4.7% 11.0 2.0*

Fall 29 3.3% 9.5 2.0*

Excessive Cold 27 3.1% 7.1 0.7*

Exposure To Smoke & Fire 23 2.6% 4.6 0.9*

Off-Road Vehicle 21 2.4% 4.4 0.5*

Other 100 11.4% n/a n/a



Total 878 100.0% 196.5 1.1*



Arctic Slope Region


Summary

Falls (27.7%), suicide attempts (15.3%), and assaults (11.0%) were the three leading causes of injury hospitalizations during 1992-2011 among Arctic Slope Alaska Native people, and represented more than half of all Arctic Slope injury hospitalizations (54.0%).

Off-road vehicles were a significant cause of injury hospitalizations among Arctic Slope Alaska Native people. The all-terrain vehicle/snow machine injury hospitalization rates for Arctic Slope Alaska Native people were significantly higher (rate ratio = 2.0 and 1.9, respectively) than that for Alaska Native people statewide (12.5/13.7 and 6.1/7.2 per 10,000, respectively, p<0.05).

Table 6. Leading Causes of Arctic Slope Injury Hospitalizations, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Arctic Slope AN/AI

vs. Alaska AN/AI 1

Suicide Attempt or Self Harm 231 15.3% 20.9 0.9

Assault 167 11.0% 16.8 0.9*


Falls 420 27.7% 62.6 1.1*

All-Terrain Vehicle 142 9.4% 12.5 2.0*

Snowmachine 141 9.3% 13.7 1.9*



Cut 41 2.7% 4.3 1.0

Natural and Environmental 34 2.2% 3.4 1.0

Other 193 12.7% n/a n/a



Total Injuries 1,514 100.0% 167.1 1.1*



Table 7. Leading Causes of Arctic Slope Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Arctic Slope Region

Injury Deaths






n/a Not applicable


Summary

Suicide (36.1%), off-road vehicle incidents (11.1%), and drowning (10.4%) were the three leading causes of injury death during 1992-2011 among Arctic Slope Alaska Native people, and represented more than half of all Arctic Slope injury deaths (57.6%).

The off-road vehicle crash death rate for Arctic Slope Alaska Native people was significantly higher (rate ratio = 2.0) than that for Alaska Native people statewide (17.7 and 8.9 per 100,000, respectively, p<0.05).


Arctic Slope AN/AI

vs. Alaska AN/AI 1

Suicide 52 36.1% 50.9 1.2*

Homicide 12 8.3% 12.9 0.9


Off-Road Vehicle 16 11.1% 17.7** 2.0*

Drowning 15 10.4% 16.2** 0.8*

Motor Vehicle 11 7.6% 11.8** 0.7*


Excessive Cold 7 4.9% ¶ n/a

Threats To Breathing 5 3.5% ¶ n/a



Undetermined Intent §§ n/a n/a n/a

Total 144 100.0% 153.8 0.9*



Bristol Bay Region


Summary

Falls (28.2%), all-terrain vehicle incidents (12.4%), and suicide attempts (10.0%) were the three leading causes of injury hospitalizations during 1992-2011 among Bristol Bay Alaska Native people, and represented about half of all Bristol Bay injury hospitalizations (50.6%).

Off-road vehicles were a significant cause of injury hospitalizations among Bristol Bay Alaska Native people. The all-terrain vehicle and snow machine injury hospitalization rates for Bristol Bay Alaska Native people were significantly higher (rate ratio = 3.0 and 1.7, respectively) than that for Alaska Native people statewide (18.4/12.0 and 6.1/7.2 per 10,000, respectively, p<0.05).

Table 8. Leading Causes of Bristol Bay Injury Hospitalizations, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Bristol Bay AN/AI

vs. Alaska AN/AI 1


Assault 149 9.5% 15.8 0.8*


Falls 443 28.2% 57.1 1.0


Snowmachine 118 7.5% 12.0 1.7*


Other Vehicle 69 4.4% 6.9 1.4*



Other 248 15.8% n/a n/a



Total Injuries 1,569 100.0% 167.0 1.1*



Table 9. Leading Causes of Bristol Bay Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Bristol Bay Region

Injury Deaths






n/a Not applicable

Summary

Drowning (20.1%), suicide (13.1%), and off-road vehicle incidents (12.1%) were the three leading causes of injury death during 1992-2011 among Bristol Bay Alaska Native people, and represented almost half of all Bristol Bay injury deaths (45.1%).

The off-road vehicle crash death rate for Bristol Bay Alaska Native people was significantly higher (rate ratio = 2.5) than that for Alaska Native people statewide (22.4 and 8.9 per 100,000, respectively, p<0.05).


Bristol Bay AN/AI

vs. Alaska AN/AI 1

Suicide 26 13.1 27.3 0.7*

Homicide 13 6.5 12.9** 0.9

Total Intentional Injuries 39 19.6 40.2 0.7*

Drowning 40 20.1 39.7 2.1*

Off-Road Vehicle 24 12.1 22.4 2.5*

Poisoning 19 9.5 20.8** 1.0

Excessive Cold 14 7.0 16.1** 1.7*

Motor Vehicle 10 5.0 10.9** 0.6*

Exposure To Smoke & Fire 6 3.0 ¶ n/a

Threats To Breathing 5 2.5 ¶ n/a

Other 32 16.1 n/a n/a

Total Unintentional Injuries 150 75.4 159.7 1.4*

Undetermined Intent 10 5.0 n/a n/a

Total 199 100.0 212.7 1.2*



Copper River/Prince William Sound Region


Summary

Falls (32.3%), motor vehicle incidents (19.5%), and assaults (10.5%) were the three leading causes of injury hospitalizations during 1992-2011 among Copper River/Prince William Sound (CR/PWS) Alaska Native people, and represented about two thirds of all CR/PWS injury hospitalizations (62.3%).

The motor vehicle hospitalization rate for CR/PWS Alaska Native people was significantly higher (rate ratio = 1.9) than that for Alaska Native people statewide (26.4 and 13.7 per 10,000, respectively, p<0.05).

Table 10. Leading Causes of Copper River/Prince William Sound Injury Hospitalizations, 1992-2011 Data Source: Alaska Trauma Registry





n/a Not applicable


Mechanism of Injury n % Rate §CR/PWS AN/AI

vs. Alaska AN/AI 1

Assault 42 10.5% 15.3 0.8



Falls 129 32.3% 52.2 0.9

Motor Vehicle 78 19.5% 26.4 1.9*

Other Vehicle 18 4.5% ¶ n/a

Cut 15 3.8% ¶ n/a

All-Terrain Vehicle 14 3.5% ¶ n/a

Struck By Person/Object 13 3.3% ¶ n/a

Snowmachine 10 2.5% ¶ n/a




Total Injuries 400 100.0% 142.6 0.9*



Table 11. Leading Causes of Copper River/Prince William Sound Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Copper River/Prince William Sound Region

Injury Deaths




n/a Not applicable



Summary

Motor vehicle incidents (34.7%), suicide (16.3%), and homicide (10.2%) were the three leading causes of injury death during 1992-2011 among Copper River/Prince William Sound (CR/PWS) Alaska Native people, and represented about two thirds of all CR/PWS injury deaths (61.2%).

The motor vehicle incident death rate for CR/PWS Alaska Native people was significantly higher (rate ratio = 3.2) than that for Alaska Native people statewide (56.6 and 17.6 per 100,000, respectively, p<0.05).


CR/PWS AN/AI

vs. Alaska AN/AI 1

Suicide 8 16.3% ¶ n/a


Total Intentional Injuries 13 26.5% 47.9 0.9

Motor Vehicle 17 34.7% 56.6** 3.2*



Total 49 100.0% 175.0 1.0



Interior Region


Summary

Falls (27.1%), suicide attempts (19.6%), and assaults (14.9%) were the three leading causes of injury hospitalizations during 1992-2011 among Interior Alaska Native people, and represented about two thirds of all Interior injury hospitalizations (61.6%).

The suicide attempt or self harm/snowmachine injury hospitalization rates for Interior Alaska Native people were significantly higher (both rate ratios = 1.3) than that for Alaska Native people statewide (28.7/9.3 and 9.3/7.2 per 10,000, respectively, p<0.05).

Table 12. Leading Causes of Interior Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Interior AN/AI

vs. Alaska AN/AI 1


Assault 571 14.9% 23.7 1.2*


Falls 1,040 27.1% 55.4 1.0

Motor Vehicle 369 9.6% 14.8 1.1

Snowmachine 234 6.1% 9.3 1.3*


Cut 102 2.7% 4.0 0.9


Struck By Person/Object 78 2.0% 3.2 0.9

Other 444 11.6% n/a n/a

Total Unintentional Injuries 2,485 64.8% 112.7 1.0


Total Injuries 3,837 100.0% 166.2 1.1*



Table 13. Leading Causes of Interior Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Interior Region

Injury Deaths




** Rate is based on 10-19 deaths and should be interpreted with caution.

n/a Not applicable

Summary

Suicide (28.6%), drowning (12.3%), and unintentional poisoning (10.8%) were the three leading causes of injury death during 1992-2011 among Interior Alaska Native people, and represented more than half of all Interior injury deaths (51.7%).

The death rate due to exposure to smoke and fire for Interior Alaska Native people was significantly higher (rate ratio = 2.0) than that for Alaska Native people statewide (10.8 and 5.3 per 100,000, respectively, p<0.05).


Interior AN/AI

vs. Alaska AN/AI 1

Suicide 132 28.6% 51.8 1.3*

Homicide 46 10.0% 20.0 1.4*


Drowning 57 12.3% 24.7 1.3*

Poisoning 50 10.8% 21.8 1.0

Motor Vehicle 44 9.5% 18.3 1.0


Exposure To Smoke & Fire 22 4.8% 10.8 2.0*

Off-Road Vehicle 20 4.3% 8.2 0.9

Threats To Breathing 11 2.4% 3.5** 0.6*




Total 462 100.0% 197.4 1.1*



Kenai Peninsula Region


Summary

Falls (32.9%), motor vehicle incidents (20.0%), and suicide attempts (12.5%) were the three leading causes of injury hospitalizations during 1992-2011 among Kenai Peninsula (Kenai)Alaska Native people, and represented about two thirds of all Kenai injury hospitalizations (65.5%).

The assault injury hospitalization rate for Kenai Alaska Native people was significantly lower (rate ratio = 0.4) than that for Alaska Native people statewide (7.4 and 19.5 per 10,000, respectively, p<0.05).

Table 14. Leading Causes of Kenai Peninsula Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry





n/a Not applicable

Mechanism of Injury n % Rate §Kenai AN/AI

vs. Alaska AN/AI 1


Assault 59 6.9% 7.4 0.4*


Falls 281 32.9% 47.5 0.8*

Motor Vehicle 171 20.0% 20.0 1.5*


Struck By Person/Object 27 3.2% 3.0 0.9

Cut 26 3.0% 2.8 0.7*



Other 101 11.8% n/a n/a



Total Injuries 853 100.0% 113.5 0.7*



Table 15. Leading Causes of Kenai Peninsula Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Kenai Peninsula Region

Injury Deaths






n/a Not applicable

Summary

Motor vehicle incidents (32.2%), suicide (21.1%), unintentional poisoning (10.0%), and drowning (10.0%) were the four leading causes of injury death during 1992-2011 among Kenai Peninsula (Kenai) Alaska Native people, and represented about three quarters of all Kenai injury deaths (73.3%).

The motor vehicle crash death rate for Kenai Alaska Native people was significantly higher (rate ratio = 1.9) than that for Alaska Native people statewide (33.6 and 17.6 per 100,000, respectively, p<0.05).


Kenai AN/AI

vs. Alaska AN/AI 1

Suicide 19 21.1% 22.0** 0.5*


Motor Vehicle 29 32.2% 33.6 1.9*






Total 90 100.0% 109.4 0.6*



Kodiak Region


Summary

Falls (32.7%), suicide attempts (15.5%), and assaults (9.5%) were the three leading causes of injury hospitalizations during 1992-2011 among Kodiak Alaska Native people, and represented over half of all Kodiak injury hospitalizations (57.6%).

The all-terrain vehicle injury hospitalization rate for Kodiak Alaska Native people was significantly higher (rate ratio = 1.3) than that for Alaska Native people statewide (7.9 and 6.1 per 10,000, respectively, p<0.05).

Table 16. Leading Causes of Kodiak Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry





n/a Not applicable

§§ Categories with fewer than five hospitalizations are not reported

Mechanism of Injury n % Rate §Kodiak AN/AI

vs. Alaska AN/AI 1


Assault 43 9.5% 9.9 0.5*


Falls 148 32.7% 40.8 0.7*


All-Terrain Vehicle 38 8.4% 7.9 1.3



Cut 11 2.4% ¶ n/a





Total Injuries 453 100.0% 109.9 0.7*



Table 17. Leading Causes of Kodiak Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Kodiak Region

Injury Deaths






n/a Not applicable


Summary

Suicide (22.7%), unintentional poisoning (18.2%), and drowning (18.2%) were the three leading causes of injury death during 1992-2011 among Kodiak Alaska Native people, and represented more than half of all Kodiak injury deaths (59.1%).

The suicide death rate for Kodiak Alaska Native people was significantly lower (rate ratio = 0.6) than that for Alaska Native people statewide (25.3 and 40.9 per 100,000, respectively, p<0.05).


Kodiak AN/AI

vs. Alaska AN/AI 1

Suicide 10 22.7% 25.3** 0.6*

Total Intentional Injuries 12 27.3% 30.4** 0.6*







Total 44 100.0% 106.9 0.6*



Northwest Arctic Region


Summary

Suicide attempts (22.4%), falls (20.4%), and assaults (14.5%) were the three leading causes of injury hospitalizations during 1992-2011 among Northwest Arctic (NW Arctic) Alaska Native people, and represented over half of all NW Arctic injury hospitalizations (57.3%).

Off-road vehicles were a significant cause of injury hospitalizations among NW Arctic Alaska Native people. The snow machine/all-terrain vehicle injury hospitalization rates for NW Arctic Alaska Native people were significantly higher (rate ratio = 3.1 and 2.4, respectively) than those for Alaska Native people statewide (22.7/14.4 and 7.2/6.1 per 10,000, respectively, p<0.05).

Table 18. Leading Causes of Northwest Arctic Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §NW Arctic AN/AI

vs. Alaska AN/AI 1


Assault 333 14.5% 29.6 1.5*


Falls 468 20.4% 53.9 0.9

Snowmachine 268 11.7% 22.7 3.1*




Cut 59 2.6% 4.7 1.1


Other 240 10.4% n/a n/a



Total Injuries 2,296 100.0% 202.4 1.3*



Table 19. Leading Causes of Northwest Arctic Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Northwest Arctic Region

Injury Deaths






n/a Not applicable

Summary

Suicide (38.4%), drowning (16.4%), and off-road vehicle incidents (9.1%) were the three leading causes of injury death during 1992-2011 among Northwest Arctic (NW Arctic) Alaska Native people, and represented about two thirds of all NW Arctic injury deaths (63.8%).

The off-road vehicle crash death rate for NW Arctic Alaska Native people was significantly higher (rate ratio = 2.6) than that for Alaska Native people statewide (22.7 and 8.9 per 100,000, respectively, p<0.05).


NW Arctic AN/AI

vs. Alaska AN/AI 1

Suicide 89 38.4% 72.4 1.8*



Drowning 38 16.4% 31.1 1.6*


Poisoning 13 5.6% 13.5** 0.6*

Excessive Cold 13 5.6% 12.0** 1.3*

Exposure To Smoke & Fire 11 4.7% 8.4** 1.6*

Threats To Breathing 9 3.9% ¶ n/a





Total 232 100.0% 203.3 1.2*



Norton Sound Region


Summary

Suicide attempts (28.3%), falls (23.3%), and assaults (9.1%) were the three leading causes of injury hospitalizations during 1992-2011 among Norton Sound Alaska Native people, and represented over half of all Norton Sound injury hospitalizations (60.7%).

Off-road vehicles were a significant cause of injury hospitalizations among Norton Sound Alaska Native people. The all-terrain vehicle/snow machine injury hospitalization rates for Norton Sound Alaska Native people were significantly higher (rate ratio = 2.3 and 1.6, respectively) than those for Alaska Native people statewide (14.2/11.4 and 6.1/7.2 per 10,000, respectively, p<0.05).

Table 20. Leading Causes of Norton Sound Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Norton Sound AN/AI

vs. Alaska AN/AI 1


Assault 234 9.1% 17.8 0.9


Falls 599 23.3% 56.1 1.0


Snowmachine 159 6.2% 11.4 1.6*

Motor Vehicle 118 4.6% 8.2 0.6*



Poisoning 63 2.5% 3.6 1.7*

Other 298 11.6% n/a n/a



Total Injuries 2,570 100.0% 190.1 1.2*



Table 21. Leading Causes of Norton Sound Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Norton Sound Region

Injury Deaths






n/a Not applicable

Summary

Suicide (40.2%), motor vehicle incidents (8.2%), and drowning (8.2%) were the three leading causes of injury death during 1992-2011 among Norton Sound Alaska Native people, and represented more than half of all Norton Sound injury deaths (56.5%).

The off-road vehicle crash death rate for Norton Sound Alaska Native people was significantly higher (rate ratio = 2.0) than that for Alaska Native people statewide (17.7 and 8.9 per 100,000, respectively, p<0.05).


Norton Sound AN/AI

vs. Alaska AN/AI 1

Suicide 123 40.2% 79.4 1.9*

Homicide 16 5.2% 12.2** 0.9*


Drowning 25 8.2% 18.0 0.9

Motor Vehicle 25 8.2% 18.1 1.0

Poisoning 24 7.8% 21.7 1.0


Excessive Cold 16 5.2% 15.7** 1.6*


Exposure To Smoke & Fire 8 2.6% ¶ n/a




Total 306 100.0% 223.5 1.3*



Southeast Region


Summary

Falls (36.6%), suicide attempts (15.5%), and assaults (11.8%) were the three leading causes of injury hospitalizations during 1992-2011 among Southeast Alaska Native people, and represented about two thirds of all Southeast injury hospitalizations (63.9%).

The sports injury hospitalization rate for Southeast Alaska Native people was significantly higher (rate ratio = 2.1) than that for Alaska Native people statewide (3.3 and 1.5 per 10,000, respectively, p<0.05).

Table 22. Leading Causes of Southeast Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Southeast AN/AI

vs. Alaska AN/AI 1


Assault 508 11.8% 18.6 1.0

Total Intentional Injuries 1,175 27.3% 42.3 1.0

Falls 1,573 36.6% 69.8 1.2*

Motor Vehicle 428 10.0% 15.5 1.1*

Other Vehicle 207 4.8% 7.3 1.5*


Cut 136 3.2% 5.1 1.2*

Sports 102 2.4% 3.3 2.1*

Poisoning 85 2.0% 2.4 1.1




Total Injuries 4,299 100.0% 167.0 1.1*



Table 23. Leading Causes of Southeast Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Southeast Region

Injury Deaths





n/a Not applicable

Summary

Suicide (22.0%), drowning (20.1%), and unintentional poisoning (12.1%) were the three leading causes of injury death during 1992-2011 among Southeast Alaska Native people, and represented more than half of all Southeast injury deaths (54.2%).

The intentional injury death rate for Southeast Alaska Native people was significantly lower (rate ratio = 0.5) than that for Alaska Native people statewide (28.7 and 55.2 per 100,000, respectively, p<0.05).


Southeast AN/AI

vs. Alaska AN/AI 1

Suicide 60 22.0% 22.1 0.5*

Homicide 17 6.2% 6.5 0.5*


Drowning 55 20.1% 21.6 1.1*

Poisoning 33 12.1% 13.2 0.6*

Motor Vehicle 32 11.7% 11.5 0.7*


Fall 10 3.7% 5.5** 1.1




Total 273 100.0% 109.6 0.6*



Yukon-Kuskokwim Region


Summary

Falls (23.9%), suicide attempts (18.0%), and assaults (12.1%) were the three leading causes of injury hospitalizations during 1992-2011 among Yukon-Kuskokwim (Y-K) Alaska Native people, and represented over half of all Y-K injury hospitalizations (54.0%).

Off-road vehicles were a significant cause of injury hospitalizations among Y-K Alaska Native people. The snow machine and all-terrain vehicle injury hospitalization rates for Y-K Alaska Native people were significantly higher (rate ratio = 1.9 and 1.2, respectively) than those for Alaska Native people statewide (14.1/7.2 and 7.2/6.1 per 10,000, respectively, p<0.05).

Table 24. Leading Causes of Yukon-Kuskokwim Injury Hospitalization, 1992-2011 Data Source: Alaska Trauma Registry




n/a Not applicable

Mechanism of Injury n % Rate §Y-K AN/AI

vs. Alaska AN/AI 1


Assault 653 12.1% 18.0 0.9*


Falls 1,292 23.9% 46.9 0.8*

Snowmachine 530 9.8% 14.1 1.9*


Cut 243 4.5% 5.9 1.4*

Other Vehicle 182 3.4% 4.4 0.9*

Natural and Environmental 155 2.9% 3.9 1.2


Other 868 16.1% n/a n/a



Total Injuries 5,399 100.0% 146.6 0.9*



Table 25. Leading Causes of Yukon-Kuskokwim Injury Deaths, 1992-2011 Data Source: Alaska Bureau of Vital Statistics

Yukon-Kuskokwim Region

Injury Deaths





n/a Not applicable

Summary

Suicide (33.6%), drowning (18.4%), and off-road vehicle incidents (7.9%) were the three leading causes of injury death during 1992-2011 among Yukon-Kuskokwim (Y-K) Alaska Native people, and represented more than half of all Y-K injury deaths (59.9%).

The drowning death rate for Y-K Alaska Native people was significantly higher (rate ratio = 1.6) than that for Alaska Native people statewide (31.0 and 19.2 per 100,000, respectively, p<0.05).


Y-K AN/AI

vs. Alaska AN/AI 1

Suicide 221 33.6% 52.5 1.3*

Homicide 49 7.4% 13.3 0.9


Drowning 121 18.4% 31.0 1.6*



Poisoning 42 6.4% 12.2 0.6*

Motor Vehicle 19 2.9% 4.5** 0.3*

Exposure To Smoke & Fire 19 2.9% 5.2** 1.0





Total 658 100.0% 171.9 1.0



Notes

Special Topics

SPECIAL TOPICS 71


I. Drug and Alcohol Poisonings

In response to inquiries received from communities three special topics are covered in this section: drug and alcohol poisonings, injuries associated with drug and alcohol use, and access to care. Additional data are available in tables B61-65 in Appendix B.

The rate of unintentional drug and alcohol poisoning deaths for AN/AI increased significantly during 1996–2011, most of this increase since 2007. The drug death rate increased 2.7 times from 1996-1999 to 2008-2011 (6.1 and 16.4 per 100,000, respectively, Figure 55). The alcohol death rate increased 5.0 times from 1996-1999 to the 2008-2011 (4.2 and 21.1 per 100,000, respectively, Figure 55).

The observed increase may be largely explained by changes in classification. Between 2007 and 2009 acute drug or alcohol intoxication codes associated with behavioral health were discontinued. The Centers for Disease Control and Prevention (personal communication, 2013) indicated that most acute intoxications that historically would have been assigned one of the discontinued codes were subsequently assigned to unintentional poisoning. The acute intoxication by drugs or alcohol codes were not previously counted as poisoning injuries because they were classified under behavioral

Data on drug and alcohol poisoning are reported as unintentional or intentional injuries. Unintentional poisonings result from unplanned overconsumption of alcohol or drugs. Intentional poisoning is the deliberate overconsumption of alcohol or drugs and is typically categorized as a suicide, suicide attempt, homicide, or assault.

A. Unintentional Poisoning Deaths

During 2002–2011, alcohol and drug poisoning combined were the mechanisms for 15.8% of all unintentional injury deaths for people of all ages in Alaska and 14.4% of all AN/AI injury deaths. Among the 276 AN/AI unintentional poisoning deaths, 142 (51.4%) were caused by drugs, 114 (41.3%) by alcohol, and 20 (7.2%) by solvents, gases, vapors and other poisons. In contrast, in 2010 nationwide, 90.8% of unintentional poisoning deaths involved drugs per the Centers for Disease Control and Prevention WISQARSTM. The age-adjusted rate of unintentional alcohol and drug poisoning deaths for AN/AI (25.3 per 100,000) was 2.3 times that of non-Natives (10.9 per 100,000) in Alaska.

** Rate is based on 10-19 deaths and should be interpreted with caution.

Figure 55. Alaska Native Unintentional Poisoning Death Rate, Type and Year, 1996-2011 Data Source: Alaska Bureau of Vital Statistics

Special Topics

6.1

16.4

4.2**

21.1

0

5

10

15

20

25

1996-1999 2000-2003 2004-2007 2008-2011

Age

-ad

just

ed

rate

pe

r 100

,000

Drugs Alcohol

72 SPECIAL TOPICS


health codes. This change must be taken into consideration for both deaths and hospitalization injuries when comparing poisoning data before and after 2007.

B. Unintentional Poisoning Hospitalizations Among Children

The Alaska Trauma Registry reports all classes of poisoning hospitalizations for patients aged 17 and younger. During 2002–2011, 549 Alaskan children aged 17 and younger were hospitalized for an unintentional poisoning; 291 (53.0%) were Alaska Native/American Indian (AN/AI) children (Table 26). Alcohol and prescription or illicit drugs were the most frequently reported poisons involved. Other poisons reported included non-potable alcohols and petroleum products.

Table 26. Frequency of Unintentional Poisoning Hospitalization among Alaska Native Children by

Poison Type (N = 549) - Alaska, 2002-2011 Data Source: Alaska Trauma Registry

Drug and Alcohol Poisonings (continued)

Ages 0–9 Years Ages 10–17 Years Total

Alcohol Drugs Other Poisons Alcohol Drugs Other Poisons

n % n % n % n % n % n % n

AN/AI <5 (<2%) 86 (78.9%) 23 (21.1%) 132 (72.5%) 27 (14.8%) 23 (12.6%) 291

Non-Native <5 (<2%) 136 (77.7%) 37 (21.1%) 22 (26.5%) 45 (54.2%) 16 (19.3%) 258

Among all Alaskan children aged 0–9 years, drugs were the cause of three out of four unintentional poisoning hospitalizations (78.7%). Among AN/AI children aged 10–17 years, alcohol caused three out of four unintentional poisoning hospitalizations (72.5%, Table 26). This proportion of unintentional poisoning hospitalizations caused by alcohol was 2.7 times that of non-Natives of the same age. For unintentional alcohol poisoning, AN/AI females aged 0 to 17 years had a hospitalization frequency (84) 1.8 times greater than AN/AI males of the same age (48). Frequencies of unintentional drug poisoning hospitalizations for AN/AI children ages 0 to 17 years were similar for males (60) and females (53).

C. Intentional Poisonings

During 2002–2011 among all AN/AI people in Alaska, there were comparatively few intentional alcohol and drug poisoning deaths (24) and self-inflicted alcohol poisoning hospitalizations (70). The majority of intentional poisonings were hospitalizations from self-inflicted drug use (2,121). The Alaska Trauma Registry did not collect self-inflicted poisoning hospitalizations after January 1, 2011.

During 2002-2010, 2,121 of the 14,914 total injury hospitalizations among AN/AI people (14.2%) resulted from self-inflicted drug poisoning, compared with 2,296 of the 26,415 total injuries among non-Natives (8.7%). These injuries made up the majority of the suicide attempt hospitalizations for both AN/AI people (73.1%) and non-Natives (82.4%). Two drug types, (1) analgesics, antipyretics, and antirheumatics (e.g., Ibuprofen, Vicodin, Prednisone) and (2) tranquilizers and psychotropic agents (e.g., Ativan, Thorazine) caused about half of the suicide attempt hospitalizations for AN/AI people (48.3%) and non-Natives (53.8%).

AN/AI 20-29 year olds had a self-inflicted drug poisoning hospitalization rate (40.7 per 10,000) 1.6 times that of AN/AI 10-19 and 30-39 year olds (both 25.2 per 10,000). AN/AI people aged 10-29 years represented nearly two thirds (61.0%) of all AN/AI hospitalizations for self-inflicted drug poisoning.

SPECIAL TOPICS 73


A significant increase in self-inflicted drug poisoning hospitalizations rates over time was exhibited for all Alaskans (Figure 56, p<0.05).

Females had higher rates of self-inflicted drug poisoning hospitalizations than males. The rate for AN/AI women (28.1 per 10,000) was 2.5 times that of AN/AI men (11.4 per 10,000). The Norton Sound region (35.6 per 10,000) had the highest rate of self-inflicted drug poisoning hospitalization. The Copper River/Prince William Sound region (8.2 per 10,000) had the lowest rates (Table 27).

Table 27. Alaska Native Self-Inflicted Drug Poisoning Hospitalization Rates, 2002-2010 Data Source: Alaska Trauma Registry

Region of Occurrence n Rate§

Norton Sound 526 35.6

Northwest Arctic 353 30.0

Interior 533 21.8

Southeast 478 18.0

Arctic Slope 171 16.5

Yukon-Kuskokwim 601 14.2

Anchorage and Matanuska-Susitna 730 13.6

Kodiak Area 54 12.7

Bristol Bay 103 10.5

Kenai Peninsula 72 8.7

Copper River/Prince William Sound 23 8.2

Aleutians and Pribilofs 7 ¶

Total 3,657 18.0

§ Hospitalization rate per 10,000 age-adjusted to 2000 US standard population ¶ Rate not calculated due to small number of hospitalizations (<20)

Drug and Alcohol Poisonings (continued)

Figure 56. Self-Inflicted Drug Poisoning Hospitalization Rate by Race and Year, 1992-2010 Data Source: Alaska Trauma Registry

10.0

19.5

2.8 4.3

0

5

10

15

20

25

1992-1995 1996-1999 2000-2003 2004-2007 2008-2010

Age

-ad

just

ed

rate

pe

r 10,

000

Alaska Native/American Indian Non-Native

74 SPECIAL TOPICS


The Alaska Trauma Registry (ATR) reports whether alcohol or drugs were known or suspected to be involved with the injury. The criteria for known involvement is “having a positive alcohol or drug blood test or breathalyzer result within 6 hours of injury” (ATR Field Data Dictionary, 2006). Cases with suspected association are those with “any documentation in the medical record that alcohol or Illicit drugs were involved” (ATR Field Data Dictionary, 2006). These data focus on the patient and do not reflect cases where someone other than the patient involved with causing the injury was under the influence.

Not all injury hospitalization patients could be tested for alcohol or drugs. Among 6,799 Alaska Native (AN/AI) injury hospitalizations reported as having an association with alcohol in the ATR during 2002–2011, 3,790 (55.7%) included a positive blood alcohol test result. From 2002-2011, 1,679 (66.4%) of the 2,259 AN/AI injury hospitalizations coded as having drug involvement had a positive blood test for drugs.

During 2002–2011, the number of injury hospitalizations for AN/AI people with known or suspected alcohol and/or drug association was 7,483, 46.4% of the total injury hospitalizations. Of the 16,141 injury hospitalizations among AN/AI people, 6,799 (42.1%) were recorded as having alcohol involvement and 2,529 (15.7%) had drug involvement. However, many hospitalizations involved both alcohol and drugs: for those hospitalizations involved with drugs, three out of four (73.0%) also indicated alcohol involvement.

Table 28. Alaska Native Hospitalizations with Known or Suspected Alcohol or Drug Involvement by

Mechanism, 2002-2011 Data Source: Alaska Trauma Registry

II. Alcohol or Drug Use-related Injuries

Mechanism Total Injury

Hospitalizations for Mechanism

Known or Suspected Alcohol Involvement

Known or Suspected Drug Involvement

n % n %

Suicide Attempt or Self Harm 3,022 1,741 57.6% 1,126 37.3%

Assault 2,047 1,461 71.4% 380 18.6%

Total Intentional Injuries 5,069 3,202 63.2% 1,506 29.7%

Falls 4,809 1,412 29.4% 241 5.0%

Motor Vehicle 1,375 624 45.4% 268 19.4%

All-terrain Vehicle 776 261 33.6% 91 11.8%

Snowmachine 749 301 40.2% 123 16.4%

Other Injury Incidents 3,363 999 29.7% 300 8.9%

Total Unintentional Injuries 11,072 3,597 32.5% 1,023 9.2%

Total Injuries 16,141 6,799 42.1% 2,529 15.7%

Among AN/AI people, the three injury mechanisms with the highest proportion of association with alcohol or drugs were assault, suicide attempt and self harm, and motor vehicle crashes.

Comparing regions, alcohol association ranged from a high of 48.0% of all AN/AI injury hospitalizations in the Interior Region to a low of 32.4% in the Kenai Peninsula Region. Injury hospitalizations suspected of having drug involvement ranged from 29.4% of all injury hospitalizations in the Copper River/Prince William Sound Region to 1.9% in the Northwest Arctic Region.

SPECIAL TOPICS 75


Table 29. Alaska Native Hospitalizations with Alcohol or Drug Involvement by Region, 2002-2011 Data Source: Alaska Trauma Registry

Region of Occurrence Total Injury

Hospitalizations for Region

Known or Suspected Alcohol Involvement

Known or Suspected Drug Involvement

n % n %

Anchorage and Matanuska-Susitna 3,913 1,787 45.7% 587 15.0%

Yukon-Kuskokwim 2,942 1,135 38.6% 407 13.8%

Southeast 1,904 736 38.7% 374 19.6%

Interior 1,895 910 48.0% 308 16.3%

Norton Sound 1,513 646 42.7% 222 14.7%

Northwest Arctic 1,263 541 42.8% 277 21.9%

Bristol Bay 810 376 46.4% 113 14.0%

Arctic Slope 724 239 33.0% 103 14.2%

Kenai Peninsula 479 155 32.4% 65 13.6%

Kodiak Area 210 85 40.5% 27 12.9%

Copper River/Prince William Sound 203 90 44.3% 19 9.4%

Aleutians and Pribilofs 133 54 40.6% 8 6.0%

The proportion of injury hospitalizations with alcohol association was similar for males (43.6%) and females (40.3%). This was also true for drug involvement (males 15.5% and females 15.8%). AN/AI people aged 20–29 had the highest rates of suspected association with drugs (51.4 per 10,000) or alcohol (119.1 per 10,000). AN/AI injury hospitalization rates with alcohol involvement increased significantly (p<0.05) from 53.9 per 10,000 to 57.4 per 10,000 during 1992–2011. During that time rates for AN/AI hospitalizations with suspected drug involvement increased 3.4 times from 5.7 to 19.4 per 10,000.

Figure 57. Rate of Hospitalizations Associated with Drugs or Alcohol by Race, Alaska, 1992-2011 Data Source: Alaska Trauma Registry

Alcohol or Drug Use-related Injuries (continued)

5.719.4

53.9 57.4

0

20

40

60

80

100

1992-1995 1996-1999 2000-2003 2004-2007 2008-2010

Age

-ad

just

edra

te p

er 1

0,00

0

Alaska Native/American Indian Non-Native

76 SPECIAL TOPICS


III. Access to Care

Because of Alaska’s unique geography, access to care differs by community. Recovery from an injury may depend on how soon an injured person reaches a healthcare facility. In Alaska, healthcare facilities range from small clinics staffed by Community Health Aides/Practitioners in remote villages to referral hospitals in Anchorage with the most advanced care capabilities. Remote Alaskan villages may have additional transportation challenges due to lack of road access and weather conditions that may prevent air or water transport. This section of the report compares injuries that occur in communities with different levels of access to care.

The “Alaska Rural Primary Care Facility Needs Assessment Project” report prepared by the Alaska Native Tribal Health Consortium, the Alaska Department of Health and Social Services, and the Indian Health Service, was given to the Denali Commission in October, 2000. It gave an “Isolation Score” for each community in Alaska, rating the level of access to medical services. It took into consideration distance to the nearest hospital, emergency medical services available, and primary mode of travel to next level of care. The table of community isolation scores from the Denali Commission report was used as the basis for the five access categories in this report. The list of how each community in Alaska was rated can be found in Appendix D.

Table 30. Distribution of Population in Alaska by Access to Care Category and Race, 2010

Location of Occurrence

Estimated Proportion of

Statewide Population *

AN/AI Non-Native

In community with highest level of hospital care in Alaska (Anchorage) 26.6% 46.1%

In community with a hospital with more limited services (e.g. Sitka) 24.5% 18.3%

On the road system within 100 miles of a hospital (e.g. Nenana) 14.0% 30.3%

Within 100 air/water miles of a hospital, or more than 100 miles by road

(e.g. King Salmon)

5.6% 2.9%

More than 100 air/water miles from a hospital (e.g. Atqasuk) 29.3% 2.4%

* Estimated from the 2010 census population counts for individual communities

A higher proportion of Alaska Native/American Indian (AN/AI) people live in the most remote communities (“more than 100 air/water miles from a hospital”) than non-Natives (29.3% and 2.4%, respectively, Table 30). Nearly one out of every three AN/AI injury hospitalizations (30.9%) and two of every five AN/AI injury deaths (42.6%) occurred in the most remote communities. Among non-Natives, less than one out of twenty injury hospitalizations or deaths (4.7%) involved events in the most remote communities. Thus, a smaller proportion of AN/AI people than non-Natives have immediate access to the level of care needed after being injured.

The rates of AN/AI injury hospitalizations are significantly lower for those injured in the most remote communities when compared to those injured in communities with a hospital (121.9 and 134.7, unadjusted rate per 10,000, respectively, p<0.05). There was no significant difference between these two community types for non-Natives (58.1 and 60.0, unadjusted rate per 10,000, respectively).

SPECIAL TOPICS 77


In contrast, the rates of injury deaths are significantly higher for both races for injuries occurring in the most remote communities (AN/AI people 164.7, non-Natives 141.9, unadjusted rate per 100,000) compared to those that happened in communities with hospitals (AN/AI people 138.9, non-Natives 86.4, unadjusted rate per 100,000, p<0.05).

Mechanisms of injury showed differences by remoteness of injury occurrence for AN/AI injury deaths and hospitalizations. The mechanisms with the greatest difference between the highest and lowest levels of access to care for hospitalizations were transportation and intentional injuries (Table 31).

Hospitalizations for assaults made up a higher proportion of AN/AI injuries occurring in Anchorage than in the most remote areas, while suicide attempts and self harm made up a higher portion of hospitalizations for injuries that occurred in the most isolated settings (Table 31).

Access to Care (continued)

Table 31. Alaska Native Injury Hospitalizations, Access to Care by Mechanism, 2002-2011

Mechanism

Access Category

Difference Least Remote (Anchorage)

Most Remote

All-Terrain Vehicle 0.2% 10.4% 10.2%

Motor Vehicle 15.0% 2.8% 12.2%

Snowmachine 0.2% 9.1% 8.9%

Assault 18.1% 10.0% 8.1%

Suicide Attempt or Self Harm 13.7% 20.3% 6.6%

For injury deaths, the mechanisms with the greatest difference between the highest and lowest levels of access to care included drowning, motor vehicles, poisoning, and suicide (Table 32).

Table 32. Alaska Native Injury Deaths, Access to Care by Mechanism, 2002-2011

Mechanism

Access Category

Difference Least Remote (Anchorage)

Most Remote

Drowning 1.2% 16.7% 15.5%

Motor Vehicle 12.7% 4.4% 8.3%

Poisoning 27.8% 6.2% 21.6%

Suicide 17.7% 39.9% 22.2%

The highest proportion of motor vehicle injuries for both hospitalizations and deaths for AN/AI people

occurred in communities “on the road system within 100 miles of a hospital” (21.4%).

78 SPECIAL TOPICS


Notes

Appendixes

APPENDIXES 79


Data Sources

Morbidity (Hospitalization) Data

Injury hospitalization data were obtained from the State of Alaska Trauma Registry (ATR). The ATR collects data on the most seriously injured patients in Alaska and the treatment they received. The ATR collects data from all 24 of Alaska’s acute care hospitals. The criteria for inclusion in the registry are patients with injuries who are admitted to an Alaska hospital, held for observation, transferred to another acute care hospital, or declared dead in the emergency department, and for whom contact with the health care system occurred within 30 days of injury.

More information about the Alaska Trauma Registry may be found at: http://dhss.alaska.gov/dph/Emergency/Pages/trauma/registry.aspx.

Mortality (Death) Data

The State of Alaska Bureau of Vital Statistics provided data from death certificates for Alaska Native people statewide from 1992 to 2011. Only injury deaths that occurred in Alaska were included. If someone was injured in Alaska and then transported to Seattle where they subsequently died, the fatality data were not included in this report. As a result, this report may underestimate injury death frequencies and rates, but not to a level of significant impact. The Alaska Bureau of Vital Statistics was informed of only 16 injury deaths occurring from 2002-2011 outside of Alaska for Alaska Native people residing in Alaska.

More information about the Alaska Bureau of Vital Statistics may be obtained at: http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx.

Population Data

The Alaska Department of Labor and Workforce Development (AKDOL) produces statistics about Alaska’s population including the annual population estimates used to calculate rates for this report. AKDOL estimates population characteristics (age, race, gender, region of residence) for each year throughout a decade by using population counts from the decennial census data before and after each decade and then making adjustments. AKDOL adjusts the census numbers, using administrative records including birth certificates, death certificates, income tax returns, Permanent Fund applications, school enrollment and driver’s licenses, to more accurately estimate the population of each year between censuses.

More information about the AKDOL’s population statistics may be found at: http://labor.alaska.gov/research/pop/popest.htm.

Determination of the Cause of Injury Categories

The categories used to classify the external causes of injuries for this report were primarily based on the 1) injury frequency and 2) International Classification of Diseases (ICD) version used by the source. As leading causes of injury death differed from those of injury hospitalization, and the ICD versions used for hospitalizations and deaths differed, different categories were selected for hospitalizations and deaths.

Appendix A. Description of Data Sources and Methods

80 APPENDIXES


Morbidity (Hospitalization) Data

The Alaska Trauma Registry used ICD-9 codes for all of the data received for this report. The ICD-9 External Cause of Injury matrix developed by ANTHC to categorize injury hospitalizations by cause for this report is in Appendix C of this document. Due to the uniqueness of modes of travel in Alaska as well as unique environmental conditions, two modifications were made to the matrix to better fit Alaskan injury hospitalizations. Below is a description of the modifications.

“Snowmachine” injuries (E820) were separated into their own category from “Other Transport”.

“ATV” injuries (E821) were separated into their own category from “Other Transport”.

To improve the accuracy of the data analysis, the narrative fields and International Classification of Diseases (ICD) codes of all cases with a mechanism classification of "OTHER" in the ATR database were reviewed to determine if the cause or mechanism could be more specifically classified. State of Alaska staff overseeing the ATR indicated that the ICD code and narrative fields in the database had the same level of accuracy. Where the ICD code and narrative fields disagreed, the narrative was used to determine the mechanism for this report, since for most cases it had more detail than the ICD code.

The narratives of all transportation categories were also reviewed to re-categorize them by the larger vehicle (if more than one transportation mode was involved) rather than the transportation mode of the patient at the time of the incident. The order of transportation modes used (from largest to smallest) was: motor vehicle (automobile, bus, truck), snowmachine, all-terrain vehicle, bicycle, and pedestrian.

The review of the data from 1992 to 2011, all races, led to 665 cases (0.75% of the total) that were grouped under a different mechanism or cause than identified by their ICD-9 code in the ATR data. The same reassignment was not done for the mortality data because a detailed narrative field was not included.

Mortality (Death) Data

The Bureau of Vital Statistics used ICD-9 codes through December, 1998, and then changed to ICD-10 codes in January, 1999. ANTHC developed ICD-9 and ICD-10 External Cause of Injury matrices to categorize injury deaths by cause for this report, described in Appendix E.

Priorities for injury prevention in Alaska are based on injury frequencies. As a result, certain activities were separated into their own categories to better describe Alaskan injury death. These included the following:

“Excessive cold” was separated into its own cause of death category from “Natural/Environmental”: X30-X31.

“Off-road Vehicle” was separated into its own category from “Other Transport”: E820.0-821.9 and V86.0-86.9.

Transport-related drowning deaths (V90, V92) were moved from the “Other Transport” category and added to the “Drowning” category. (See Appendix E for all codes assigned to drowning.)

Between 2007 and 2009 the World Health Organization discontinued the ICD-10 codes titled “Mental

Appendix A. Description of Data Sources and Methods (continued)

APPENDIXES 81


and behavioral disorders due to use of” alcohol or specific drug class, “acute intoxication”. Subsequently, “acute intoxication” cases were predominantly coded as X45 (“Accidental Poisoning”) or X60-X65 (“Intentional self poisoning using alcohol or drugs”). Prior to the discontinuation, “acute intoxication” cases were considered behavioral health cases and not included in injury surveillance. Injury data may show a substantial increase in unintentional poisonings and suicide attempts and self harm , so comparing data before and after the period of the coding change (2007-2009) should be done with caution.

Poisoning Data

All poisoning deaths, for both adults and children, are included in the Bureau of Vital Statistics data. The Alaska Trauma Registry reports all poisoning hospitalizations for patients under age 18. Until January, 2011, the ATR also reported intentional, occupational, and inhalational poisonings for adults. On January 1, 2011, the ATR discontinued reporting intentional poisoning hospitalizations for adults.

Because poisoning is a substantial proportion (75%) of the means used for suicide attempts and self harm for Alaska Native people, the sections on suicide attempts and self harm hospitalizations, pages 34 to 35, included data through 2010 only to ensure rate accuracy.

Calculation of Rates

All rates in this report were age-adjusted unless the data were annotated or stratified by age. Rates were age-adjusted to the 2000 U.S. standard population obtained from the U.S. Census. The regional maps in the Injury Hospitalization and Injury Death sections indicate whether there is a statistically significant difference between each regional rate for 2002-2011 data and the statewide AN/AI rate. Rates in the Access to Care section, pages 76 to 77, could not be age-adjusted because that level of population data segmentation was not available.

The rate ratio indicates whether the injury risk of the population of interest is greater (>1) or less (<1) than the statewide AN/AI population. In the regional profile section of this report, the regional AN/AI rates were compared to statewide AN/AI rates for calculating rate ratios. Regional non-Native rates were not used for comparison because the injury frequencies for non-Natives in several regions over this time period were below the rate-calculation threshold (10 for deaths and 20 for hospitalizations).

Population Data

“Bridged” population estimates from the Alaska Department of Labor were used as the denominator to calculate the mortality rates. To compare data over time, bridged estimates were necessary to adjust for the option added in the 2000 Census which allowed selection of multiple races rather than one. For the time trends, four years of population (denominator) and occurrence (numerator) data were summed for each time period to calculate the aggregate rates for each time period.

To calculate age-adjusted rates, the number of deaths for each ten-year age group (from 0-9 to 70+ years) was divided by the total population for that age group over the corresponding time interval. Those unadjusted rates were multiplied by the proportion that age group made up of the 2000 U.S. standard population. Those products were summed to get the overall age-adjusted rate for each time interval. All injury rates presented in this report were age-adjusted, except where annotated or age groups were used.


82 APPENDIXES


Regional Classification

Maps within this report provide injury death and hospitalization rates by region. The village where each injury occurred (rather than the village of residence) was used to determine the region for the calculation of rates. For example, an injury involving a resident of Bethel that was injured in a motor vehicle crash in Anchorage would be categorized as an Anchorage/Mat-Su injury.

Many tribal health organization (THO) service areas are geographically small, with corresponding low numbers for population, injury deaths and hospitalizations. To obtain populations and injury frequencies large enough to calculate rates, several THO service areas were combined into one region, creating a total of twelve regions. The regions are defined on page 45, at the start of the Regional Profile section of this report.

Death Data

Rates per 100,000 population were calculated for injury deaths. Death rates were not calculated for any category where the number of deaths was fewer than ten. Injury death rates based on a small number of deaths (at least 10 but less than 20) were flagged (**) because they may be unstable and should be interpreted with caution.

Hospitalization Data

Rates per 10,000 population were calculated for injury hospitalizations. Rates were not calculated where the number of hospitalizations in a category was less than twenty.

Other Notes

Alaska Native People and American Indian People

Throughout this document, both the term “Alaska Native” and the abbreviation “AN/AI” are used to refer to all Alaska Native and American Indian people who reside in Alaska.

Alcohol-related and Drug-related Injury Hospitalizations

This report presents information on alcohol- and drug-related injury hospitalizations. To be included as alcohol- or drug-related in the ATR, there must be a positive blood alcohol or drug test or breathalyzer result within six hours of injury or documentation in the medical record that alcohol or illicit drugs were involved. If a case does not meet these criteria, it will not be recorded as alcohol- or drug-related in the ATR.

Cases where someone other than the patient was involved in causing the injury and under the influence of alcohol or drugs would not be recorded as alcohol- or drug-related in the ATR. This may lead to underestimates of the number of alcohol– or drug-related injury hospitalizations.

n Values

In the data tables in Appendix B, there may be variation in the n values listed for the total number of injuries in each category. This indicates that one of the parameters used on that table (gender, age, region) was missing for a small number of cases. These cases were still included to provide as comprehensive a picture of Alaska Native injuries as possible.


APPENDIXES 83


Percentages

Calculations for percentages were rounded to one decimal place, therefore total percentages may not add up to 100.0%.

Statistical Significance

Differences between comparison rates and percentages were considered to be significantly different if the z-value was greater than the critical value at the 0.05 significance level, 1.96, and annotated in the report as p<0.05.


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84 APPENDIXES


Appendix B. Data Tables

Table B-1. Intentional Injury Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††

Norton Sound * 75 97.4

Northwest Arctic * 50 74.8

Yukon-Kuskokwim * 156 72.2


Interior 67 50.4

Anchorage and Matanuska-Susitna * 137 42.4

Bristol Bay 16 33.3**

Kenai Peninsula * 15 29.3**

Southeast 40 28.9


Copper River/Prince William Sound 7 ¶

Kodiak 5 ¶

All Alaska, Non-Native only 1,221 21.4

All Alaska, AN/AI only 603 51.6


* Regional rate is significantly different from the AN/AI statewide rate , p<0.05



APPENDIXES 85


Appendix B. Data Tables (continued)

Table B-2. Intentional Injury Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics



n Rate †† n Rate †† n Rate ††

1992-1995 194 98.5 57 30.6 251 64.6

1996-1999 180 86.6 47 23.2 227 54.6

2000-2003 163 71.9 62 27.2 225 49.6

2004-2007 181 79.9 66 28.8 247 54.4

2008-2011 191 77.5* 56 23.9 247 51.0*


1992-1995 419 39.9 92 9.9 511 25.8

1996-1999 363 36.9 104 11.0 467 24.0

2000-2003 338 32.3 96 9.1 434 20.9

2004-2007 391 34.5 95 8.5 486 21.8

2008-2011 399 32.2* 102 8.4 501 20.7*

Male Female

Alaska Non-Native

Male Female Total

Alaska AN/AI

Total

Table B- 3. Intentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Total

Suicide 478 79.3%

Homicide 125 20.7%

Total 603 100.0%

86 APPENDIXES



Table B-4. Intentional Injury Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics








Table B-5. Unintentional Injury Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††

Bristol Bay * 73 158.4


Copper River/Prince William Sound 18 122.3**



Interior 127 106.9

Aleutians and Pribilofs 17 102.6**


Kenai Peninsula * 31 75.9

Arctic Slope * 28 70.4

Southeast * 81 66.6

Kodiak 12 55.0**

All Alaska, Non-Native only 2,546 49.5

All Alaska, AN/AI only 1,036 105.1

Age n Rate †† n Rate †† n Rate ††

0-9 §§ ¶ §§ ¶ 7 ¶

10-19 38 31.7 98 78.3 136 55.5

20-29 51 62.6 171 201.2 222 133.4

30-39 26 36.4 72 100.9 98 68.6

40-49 22 28.8 63 83.3 85 56.0

50-59 6 ¶ 27 47.3 33 28.6

60-69 6 ¶ 8 ¶ 14 23.1**

70 + §§ ¶ 6 ¶ 8 ¶

Total 155 27.0 448 77.0 603 52.2

Female Male Total

APPENDIXES 87



Table B-7. Unintentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

Table B-6. Unintentional Injury Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics



n Total

Poisoning 276 26.6%

Drowning 169 16.3%

Motor vehicle 158 15.2%

Other or unspecified 124 12.0%

Off-road vehicle 98 9.5%

Excessive cold 96 9.3%

Threats to breathing 49 4.7%

Fall 35 3.4%

Smoke, fire & flames 32 3.1%

Total 1,037 100.0%


1992-1995 319 183.4 118 69.7 437 126.1

1996-1999 272 156.0 105 63.0 377 108.5

2000-2003 286 156.8 125 65.0 411 109.3

2004-2007 287 147.6 115 60.4 402 103.2

2008-2011 302 146.1* 144 72.7 446 109.5*


1992-1995 856 90.2 215 30.1 1,071 61.5

1996-1999 672 72.7 211 29.8 883 52.1

2000-2003 744 78.4 276 31.6 1,020 55.1

2004-2007 702 67.1 276 28.9 978 48.3

2008-2011 743 64.9* 303 30.9 1,046 48.6*

Total

Alaska AN/AI

Alaska Non-Native

Male Female Total

Male Female

88 APPENDIXES



Table B-8. Unintentional Injury Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics


0-9 32 29.2 55 46.5 87 38.2

10-19 36 30.0 81 64.8 117 47.8

20-29 34 41.7 143 168.3 177 106.3

30-39 62 86.8 123 172.3 185 129.5

40-49 62 81.3 125 165.4 187 123.1

50-59 36 61.8 93 163.1 129 111.9

60-69 16 51.7** 49 165.1 65 107.2

70 + 40 157.5 50 257.0 90 200.6

Total 318 55.5 719 123.6 1,037 89.8

Female Male Total







Table B-9. Suicide Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††





Interior 54 40.0

Kenai Peninsula 13 26.4**



Southeast * 28 20.2

Aleutians and Pribilofs §§ ¶


Kodiak 5 ¶

All Alaska, Non-Native only 953 16.9


APPENDIXES 89



Table B-10. Suicide Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics




1992-1995 147 73.4 37 19.3 184 46.4

1996-1999 132 59.2 29 13.2 161 36.2

2000-2003 129 56.3 35 14.6 164 35.5

2004-2007 151 66.0 50 21.5 201 43.7

2008-2011 152 60.4* 43 18.4 195 39.7*


1992-1995 309 30.7 59 6.5 368 19.2

1996-1999 260 28.2 68 7.2 328 17.6

2000-2003 262 25.8 67 6.3 329 16.1

2004-2007 292 26.6 67 6.0 359 16.4

2008-2011 334 27.2* 86 7.0 420 17.4*

Alaska Non-Native

Male Female Total

Male Female Total

Alaska AN/AI

Table B-11. Suicide Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Total

Firearm 277 58.0%

Strangulation or suffocation 164 34.3%

Poisoning 25 5.2%


Total 478 100.0%

90 APPENDIXES



Table B-12. Suicide Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics






0-9 §§ ¶ §§ ¶ §§ ¶

10-19 31 25.9 77 61.6 108 44.1

20-29 38 46.6 157 184.7 195 117.1

30-39 21 29.4 50 70.1 71 49.7

40-49 13 17.0** 54 71.4 67 44.1

50-59 §§ ¶ 22 38.6 25 21.7

60-69 §§ ¶ §§ ¶ 8 ¶

70 + §§ ¶ §§ ¶ 4 ¶

Total 111 19.4 367 63.1 478 41.4

Female Male Total






Table B-13. Poisoning Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††

Anchorage and Matanuska-Suisitna * 135 46.6


Interior 32 26.0

Norton Sound 14 25.0**

Southeast 28 21.8

Northwest Arctic 10 20.2**



Arctic Slope §§ ¶

Copper River/Prince William Sound §§ ¶

Kenai Peninsula 9 ¶

Kodiak §§ ¶

All Alaska, non-Native only 683 11.5


APPENDIXES 91



Table B-14. Poisoning Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics



Table B-15. Poisoning Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Total

Drugs or medications 142 51.4%

Alcohol 114 41.3%

Other or unspecified Poisons 20 7.2%

Total 276 100.0%


1992-1995 15 9.5 12 7.8 27 8.6

1996-1999 28 16.0 31 16.6 59 16.3

2000-2003 35 18.8 36 17.9 71 18.3

2004-2007 37 17.2 35 18.6 72 18.1

2008-2011 93 43.3* 75 35.9* 168 39.6*


1992-1995 49 4.6 15 1.6 64 3.2

1996-1999 61 5.2 29 3.7 90 4.6

2000-2003 126 10.2 83 7.8 209 9.1

2004-2007 141 11.9 80 7.0 221 9.5

2008-2011 236 17.7* 107 9.2* 343 13.7*

Male Female

Alaska AN/AI

Alaska Non-Native

Male Female Total

Total

92 APPENDIXES



Table B-16. Poisoning Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics










Table B-17. Drowning Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††

Bristol Bay * 19 41.1**


Northwest Arctic * 17 26.1**


Interior 18 14.2**

Southeast 17 12.5**


Anchorage and Matanuska-Suisitna 7 ¶

Arctic Slope 8 ¶


Kenai Peninsula §§ ¶

Kodiak §§ ¶



Age in Years n Rate †† n Rate †† n Rate ††

0-9 §§ ¶ §§ ¶ §§ ¶

10-19 §§ ¶ 8 ¶ 12 4.9**

20-29 17 20.9** 31 36.5 48 28.8

30-39 39 54.6 33 46.2 72 50.4

40-49 37 48.5 42 55.6 79 52.0

50-59 19 32.6** 27 47.3 46 39.9

60-69 9 ¶ §§ ¶ 13 21.4**

70 + §§ ¶ §§ ¶ 5 ¶

Total 129 22.5 147 25.3 276 23.9

Female Male Total

APPENDIXES 93



Table B-18. Drowning Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics





Table B-19. Drowning Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Total

While in natural water 61 36.1%

Water transport, boating 46 27.2%


Fall into natural water, not from boat 21 12.4%

Total 169 100.0%


1992-1995 89 49.4 14 6.0 103 27.6

1996-1999 74 41.7 7 ¶ 81 21.8

2000-2003 61 30.3 14 5.7 75 17.9

2004-2007 69 32.3 13 5.0 82 18.6

2008-2011 52 22.2* §§ ¶ 56 12.0*


1992-1995 144 13.1 21 2.3 165 7.9

1996-1999 98 9.2 15 1.7 113 5.6

2000-2003 90 9.2 7 ¶ 97 5.0

2004-2007 75 6.1 10 0.9 85 3.6

2008-2011 79 6.3* 12 1.2* 91 3.9*

Male Female

Alaska AN/AI

Alaska Non-Native

Male Female Total

Total

94 APPENDIXES



Table B-20. Drowning Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics






0-9 7 ¶ 12 10.1** 19 8.3**

10-19 7 ¶ 18 14.4** 25 10.2

20-29 §§ ¶ 36 42.4 37 22.2

30-39 §§ ¶ 28 39.2 31 21.7

40-49 §§ ¶ 27 35.7 30 19.8

50-59 §§ ¶ 13 22.8** 14 12.1**

60-69 §§ ¶ 7 ¶ 9 ¶

70 + §§ ¶ §§ ¶ §§ ¶

Total 24 4.2 145 24.9 169 14.6

Female Male Total






Table B-21. Motor Vehicle Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††

Kenai Peninsula * 13 28.9**

Anchorage and Matanuska-Suisitna* 70 25.5

Interior 20 15.9


Southeast * 10 7.4**

Yukon-Kuskokwim * 11 4.9**


Arctic Slope 5 ¶

Bristol Bay 6 ¶


Kodiak §§ ¶

Northwest Arctic §§ ¶



APPENDIXES 95



Table B-23. Motor Vehicle Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

Table B-22. Motor Vehicle Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics



n Total

Motor vehicle passenger 91 57.6%

Pedestrian 58 36.7%

Motorcyclist or Bicyclist 9 5.7%

Total 158 100.0%


1992-1995 49 26.7 37 20.3 86 23.7

1996-1999 51 26.5 20 10.3 71 18.2

2000-2003 56 30.2 21 11.3 77 20.2

2004-2007 45 20.7 18 7.7 63 14.2

2008-2011 34 16.4* 22 9.5* 56 12.9*


1992-1995 231 25.2 99 12.9 330 19.2

1996-1999 173 17.5 72 8.2 245 13.0

2000-2003 226 23.6 89 9.5 315 16.5

2004-2007 199 19.3 76 6.9 275 13.7

2008-2011 141 11.7* 61 5.6* 202 8.7

Alaska Non-Native

Male Female Total

Male Female Total

Alaska AN/AI

96 APPENDIXES



Table B-24. Motor Vehicle Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics





Table B-25. Homicide Death Rate†† by Region, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate ††

Anchorage and Matanuska-Suisitna* 51 16.3



Interior 13 10.4**

Southeast 12 8.8**


Arctic Slope §§ ¶

Bristol Bay §§ ¶


Kenai Peninsula §§ ¶

Kodiak §§ ¶

Northwest Arctic §§ ¶









0-9 §§ ¶ 11 9.3** 12 5.3**

10-19 14 11.7** 12 9.6** 26 10.6

20-29 9 ¶ 16 18.8** 25 15.0

30-39 9 ¶ 25 35.0 34 23.8

40-49 7 ¶ 14 18.5** 21 13.8

50-59 6 ¶ 17 29.8** 23 20.0

60-69 §§ ¶ 10 33.7** 12 19.8**

70 + §§ ¶ §§ ¶ 5 ¶

Total 51 8.9 107 18.4 158 13.7

Female Male Total

APPENDIXES 97



Table B-27. Homicide Death by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

Table B-26. Homicide Death Rate†† by Gender, Race and Year, 1992-2011 Data Source: Alaska Bureau of Vital Statistics



n Total

Firearm 62 49.6%


Sharp object 18 14.4%

Strangulation or suffocation 6 4.8%

Total 125 100.0%


1992-1995 47 25.1 20 11.3 67 18.2

1996-1999 48 27.4 18 10.0 66 18.3

2000-2003 34 15.6 27 12.7 61 14.1

2004-2007 30 14.0 16 7.4 46 10.7

2008-2011 39 17.1* 13 5.5* 52 11.3*


1992-1995 110 9.2 33 3.4 143 6.6

1996-1999 103 8.7 36 3.7 139 6.4

2000-2003 76 6.6 29 2.8 105 4.8

2004-2007 99 7.9 28 2.6 127 5.4

2008-2011 65 5.0* 16 1.4* 81 3.3*

Alaska Non-Native

Male Female Total

Male Female Total

Alaska AN/AI

98 APPENDIXES



Table B-28. Homicide Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Bureau of Vital Statistics






0-9 §§ ¶ §§ ¶ 7 ¶

10-19 7 ¶ 21 16.8 28 11.4

20-29 13 16.0 14 16.5 27 16.2

30-39 §§ ¶ 22 30.8 27 18.9

40-49 9 ¶ 9 ¶ 18 11.9**

50-59 §§ ¶ 5 ¶ 8 ¶

60-69 §§ ¶ §§ ¶ 6 ¶

70 + §§ ¶ §§ ¶ §§ ¶

Total 44 7.7 81 13.9 125 10.8

Female Male Total

Table B-29. Intentional Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry



n Rate §



Interior 619 46.6

Yukon-Kuskokwim 1,004 45.8

Southeast * 536 38.1


Anchorage and Matanuska-Suisitna * 1,163 35.6


Copper River/Prince William Sound * 38 24.9

Kodiak* 47 22.9


Aleutians and Pribilofs * 24 12.8

All Alaska, non-Native only 4,171 7.1

All Alaska, ANAI only 5,066 43.2

APPENDIXES 99


Table B-31. Intentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

Table B-30. Intentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry




n Total

Suicide Attempt 3,022 59.6%

Assault 2,047 40.4%

TOTAL 5,069 100.0%

n Rate § n Rate § n Rate §

1992-1995 804 41.4 593 30.8 1,397 36.2

1996-1999 937 45.3 821 38.5 1,758 41.9

2000-2003 983 44.9 932 40.4 1,915 42.5

2004-2007 1,093 47.9 1,122 47.9 2,215 47.9

2008-2011 1,012 42.4 916 37.9* 1,928 40.1*


1992-1995 884 7.7 555 5.4 1,439 6.6

1996-1999 898 7.8 853 8.1 1,751 8.0

2000-2003 935 7.9 974 9.1 1,909 8.5

2004-2007 887 7.3 811 7.3 1,698 7.3

2008-2011 817 6.4* 731 6.5* 1,548 6.5

Alaska AN/AI

Male Female Total

Alaska Non-Native

TotalMale Female

100 APPENDIXES


Table B-32. Intentional Injury Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry



Table B-33. Unintentional Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry

n Rate §






Southeast * 1,350 107.2

Interior 1,261 105.5

Yukon-Kuskokwim 1,913 102.9



Kodiak * 163 81.1







Age n Rate § n Rate § n Rate §

0-9 19 ¶ 30 2.5 49 2.1

10-19 691 57.6 453 36.2 1,144 46.7

20-29 787 96.6 918 108.0 1,705 102.4

30-39 420 58.8 497 69.6 917 64.2

40-49 375 49.2 449 59.4 824 54.3

50-59 143 24.6 188 33.0 331 28.7

60-69 37 12.0 28 9.4 65 10.7

70 + 14 ¶ 19 ¶ 33 7.4

Total 2,486 43.4 2,582 44.4 5,068 43.9

Female Male Total

APPENDIXES 101


Table B-35. Unintentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

Table B-34. Unintentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry




n Total

Falls 4,807 43.9%

Other Incidents 1,933 17.6%

Motor Vehicle 1,375 12.6%

ATV 776 7.1%

Snowmachine 749 6.8%

Other Vehicle 551 5.0%

Cut 391 3.6%

Poisoning 373 3.4%

Total 10,955 100.0%


1992-1995 2,363 131.8 1,462 97.0 3,825 115.3

1996-1999 2,569 137.3 1,636 99.9 4,205 119.3

2000-2003 2,776 139.2 1,820 100.9 4,596 120.5

2004-2007 2,724 130.3 1,900 101.0 4,624 116.6

2008-2011 2,337 106.9* 1,752 90.4* 4,089 100.1*


1992-1995 6,191 68.7 3,221 49.3 9,412 60.2

1996-1999 5,994 65.1 3,507 50.6 9,501 59.1

2000-2003 6,317 65.3 4,161 52.7 10,478 60.0

2004-2007 6,089 59.8 4,148 48.2 10,237 54.9

2008-2011 5,461 50.4* 3,989 43.0* 9,450 47.6*

Male Female Total

Alaska Non-Native

Male Female Total

Alaska AN/AI

102 APPENDIXES


Table B-36. Unintentional Injury Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry


Age n Rate § n Rate § n Rate §0-9 567 51.7 797 67.3 1,364 59.8

10-19 679 56.6 1,285 102.7 1,964 80.2

20-29 509 62.5 1,183 139.2 1,692 101.6

30-39 432 60.5 786 110.1 1,218 85.3

40-49 544 71.3 973 128.7 1,517 99.9

50-59 550 94.4 629 110.3 1,179 102.3

60-69 442 142.9 352 118.6 794 131.0

70 + 813 320.1 410 210.7 1,223 272.6

Total 4,536 79.1 6,415 110.3 10,951 94.8

Female Male Total


Table B-37. Falls Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry

n Rate §





Bristol Bay 223 57.1

Kenai Peninsula 166 51.5

Interior * 534 51.4

Copper River/Prince William Sound 68 49.6


Kodiak * 68 38.4







APPENDIXES 103


Table B-38. Falls Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry





1992-1995 714 48.1 733 59.4 1,447 54.7

1996-1999 773 51.8 831 60.5 1,604 57.0

2000-2003 940 56.3 927 60.4 1,867 59.0

2004-2007 950 53.3 1,007 62.9 1,957 59.2

2008-2011 877 46.0 1,070 62.0 1,947 55.3


1992-1995 2,005 29.0 1,600 30.1 3,605 30.1

1996-1999 2,039 27.3 1,940 33.1 3,979 31.0

2000-2003 2,264 27.8 2,427 34.4 4,691 31.7

2004-2007 2,403 27.5 2,541 32.5 4,944 30.6

2008-2011 2,341 24.7* 2,635 30.3 4,976 28.1

Male Female Total

Alaska Non-Native

Male Female Total

Alaska AN/AI

Table B-39. Falls Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

n Total

Same level, slipping or stumbling 2,129 44.3%


From one level to another 780 16.2%

Stairs or steps 532 11.1%

Out of building or other structure 207 4.3%

Same level,collision or shoving by person 110 2.3%

Ladders or scaffolding 103 2.1%

Total 4,809 100.0%

104 APPENDIXES


Table B-40. Falls Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry



0-9 246 22.4 295 24.9 541 23.7

10-19 137 11.4 280 22.4 417 17.0

20-29 173 21.2 274 32.2 447 26.9

30-39 189 26.5 241 33.8 430 30.1

40-49 297 38.9 397 52.5 694 45.7

50-59 385 66.1 312 54.7 697 60.5

60-69 373 120.6 195 65.7 568 93.7

70 + 716 281.9 296 152.1 1,012 225.6

Total 2,516 43.9 2,290 39.4 4,806 41.6

Female Male Total





Table B-41. Suicide Attempt or Self Harm Hospitalization Rate§ by Region, Alaska Native People, 2002-2010 Data Source: Alaska Trauma Registry

n Rate §




Interior 355 26.2

Southeast 335 23.5


Kodiak * 35 16.5








APPENDIXES 105


Table B-42. Suicide Attempt or Self Harm Hospitalization Rate§ by Gender, Race and Year, 1992-2010 Data Source: Alaska Trauma Registry





1992-1995 253 12.4 376 18.3 629 15.3

1996-1999 366 16.4 597 26.9 963 21.6

2000-2003 396 17.5 742 31.6 1,138 24.5

2004-2007 495 21.0 870 36.1 1,365 28.5

2008-2010 342 18.4* 639 35.0* 981 26.6*


1992-1995 323 2.8 461 4.5 784 3.6

1996-1999 450 3.9 752 7.1 1,202 5.4

2000-2003 468 4.0 877 8.1 1,345 6.0

2004-2007 458 3.8 722 6.5 1,180 5.12008-2010 374 4.0* 586 6.9* 960 5.4*

Male Female Total

Alaska Non-Native

Male Female Total

Alaska AN/AI

n Total

Poisoning 2,204 76.0%

Cutting or piercing instrument 371 12.8%

Firearms, air guns or explosives 131 4.5%

Hanging, strangulation or suffocation 126 4.3%


Total 2,901 100.0%

Table B-43. Suicide Attempt or Self Harm Hospitalization by Type, Alaska Native People, All Ages, 2002-2010 Data Source: Alaska Trauma Registry

106 APPENDIXES


Table B-44. Suicide Attempt or Self Harm Hospitalization Rate§, Gender and Age Group, Alaska Native People,

2002-2010 Data Source: Alaska Trauma Registry




Age n Rate § n Rate § n Rate §0-9 §§ ¶ 6 ¶ 8 ¶

10-19 610 55.5 256 22.4 866 38.7

20-29 581 81.9 383 51.8 964 66.5

30-39 297 46.0 175 27.2 472 36.6

40-49 254 36.6 140 20.4 394 28.6

50-59 95 18.7 52 10.5 147 14.6

60-69 27 10.1 8 ¶ 35 6.7

70 + 6 ¶ 8 ¶ 14 ¶

Total 1,872 34.4 1,028 19.1 2,900 26.2

Female Male Total




n Rate §


Interior 264 20.4




Bristol Bay 88 18.1






Kodiak 12 ¶



Table B-45. Assault Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry

APPENDIXES 107


Table B-46. Assault Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry





1992-1995 551 29.1 217 12.5 768 20.9

1996-1999 571 28.8 224 11.6 795 20.2

2000-2003 587 27.5 190 8.8 777 18.1

2004-2007 598 27.0 252 11.7 850 19.4

2008-2011 614 26.6* 212 9.3* 826 18.0*


1992-1995 561 4.8 94 0.9 655 3.0

1996-1999 448 3.9 101 1.0 549 2.6

2000-2003 467 4.0 97 0.9 564 2.5

2004-2007 429 3.5 89 0.8 518 2.2

2008-2011 396 3.1* 87 0.8 483 2.0*

Male Female Total

Alaska Non-Native

Male Female Total

Alaska AN/AI

Table B-47. Assault Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

n Total

Fight or brawl 1,121 54.8%


Cutting or piercing instrument 236 11.5%

Struck by blunt or thrown object 182 8.9%

Child or adult abuse 92 4.5%

Human bite 74 3.6%

Firearms or explosives 73 3.6%

Total 2,047 100.0%

108 APPENDIXES


Table B-48. Assault Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry





0-9 17 ¶ 24 2.0 41 1.8

10-19 53 4.4 177 14.2 230 9.4

20-29 190 23.3 519 61.1 709 42.6

30-39 115 16.1 307 43.0 422 29.5

40-49 115 15.1 305 40.3 420 27.7

50-59 41 7.0 135 23.7 176 15.3

60-69 10 ¶ 20 6.7 30 4.9

70 + 8 ¶ 11 ¶ 19 ¶

Total 549 9.6 1,498 25.8 2,047 17.7

Female Male Total

Table B-49. Motor Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry

n Rate §




Interior 180 13.3

Southeast 169 12.4

Kodiak 23 9.1












APPENDIXES 109


Table B-50. Motor Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry





1992-1995 312 16.7 232 12.9 544 14.8

1996-1999 370 18.1 254 13.2 624 15.7

2000-2003 385 18.0 282 13.6 667 15.8

2004-2007 305 13.6 252 11.4 557 12.5

2008-2011 274 11.0* 210 9.1* 484 10.1*


1992-1995 1,298 12.7 765 9.1 2,063 11.0

1996-1999 1,206 11.7 761 8.3 1,967 10.1

2000-2003 1,338 12.9 805 8.5 2,143 10.8

2004-2007 1,093 9.8 691 6.7 1,784 8.3

2008-2011 944 7.9* 524 4.8* 1,468 6.4

Male Female Total

Alaska Non-Native

Male Female Total

Alaska AN/AI

Table B-51. Motor Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

n Total

Collision with other vehicle 382 27.7%

Collision with pedestrian or bicyclist 363 26.3%

Crash without collision 340 24.7%

Motorcycle 135 9.8%


While boarding or alighting 59 4.3%

Total 1,378 100.0%

110 APPENDIXES


Table B-52. Motor Vehicle Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry


¶ Rate not calculated due to small number of hospitalizations (<20).



0-9 32 2.9 63 5.3 95 4.2

10-19 126 10.5 186 14.9 312 12.7

20-29 153 18.8 191 22.5 344 20.7

30-39 90 12.6 103 14.4 193 13.5

40-49 86 11.3 105 13.9 191 12.6

50-59 63 10.8 73 12.8 136 11.8

60-69 18 ¶ 33 11.1 51 8.4

70 + 33 13.0 19 ¶ 52 11.6

Total 603 10.5 773 13.3 1,376 11.9

Female Male Total

Table B-53. All-Terrain Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry




n Rate §






Interior 72 5.2

Southeast * 28 1.9



Kodiak 16 ¶




All Alaska, ANAI only 774 6.5

APPENDIXES 111


Table B-54. All-Terrain Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry





1992-1995 142 7.3 63 3.3 205 5.2

1996-1999 180 8.5 74 3.2 254 5.7

2000-2003 180 7.3 123 5.1 303 6.2

2004-2007 201 9.3 130 5.5 331 7.3

2008-2011 183 7.5 105 4.3* 288 5.9*


1992-1995 139 1.3 48 0.5 187 0.9

1996-1999 171 1.5 33 0.3 204 1.0

2000-2003 189 1.7 66 0.6 255 1.2

2004-2007 255 2.1 105 0.9 360 1.6

2008-2011 241 2.0* 96 0.9* 337 1.4*

Male Female Total

Alaska Non-Native

Alaska AN/AI

Male Female Total

Table B-55. All-Terrain Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

n Total

ATV Driver 473 61.1%

ATV Passenger 193 24.9%


Pedestrian 50 6.5%

Total 774 100.0%

112 APPENDIXES


Table B-56. All-Terrain Vehicle Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry





0-9 29 2.6 46 3.9 75 3.3

10-19 123 10.4 144 11.5 269 11.0

20-29 48 5.9 121 14.2 169 10.2

30-39 27 3.8 72 10.1 99 6.9

40-49 28 3.7 49 6.5 77 5.1

50-59 16 ¶ 17 ¶ 33 2.9

60-69 6 ¶ 10 ¶ 16 ¶

70 + 20 7.9 18 ¶ 38 8.5

Total 297 5.2 477 8.2 776 6.7

Female Male Total

Table B-57. Snowmachine Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry



§§ Categories with fewer than five hospitalizations are not reported


n Rate §






Interior 98 7.3


Copper River/Prince William Sound * 9 ¶



Kodiak §§ ¶

Southeast §§ ¶


All Alaska, ANAI only 749 6.5

APPENDIXES 113


Table B-58. Snowmachine Hospitalization Rate§ by Gender, Race and Year, 1992-2011 Data Source: Alaska Trauma Registry





1992-1995 214 11.1 72 3.8 286 7.5

1996-1999 257 12.6 76 3.9 333 8.3

2000-2003 267 12.4 83 3.8 350 8.0

2004-2007 232 10.2 82 3.5 314 6.8

2008-2011 204 9.0* 58 2.4* 262 5.6*


1992-1995 177 1.5 36 0.3 213 1.0

1996-1999 222 1.9 54 0.5 276 1.3

2000-2003 241 2.1 57 0.5 298 1.3

2004-2007 195 1.6 44 0.4 239 1.0

2008-2011 156 1.2* 46 0.4 202 0.8*

Male Female Total

Alaska Non-Native

Alaska AN/AI

Male Female Total

Table B-59. Snowmachine Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 Data Source: Alaska Trauma Registry

n Total

Snowmachine Driver 541 72.2%

Snowmachine Passenger 115 15.4%


Pedestrian 41 5.5%

Total 749 100.0%

114 APPENDIXES


Table B-60. Snowmachine Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 Data Source: Alaska Trauma Registry





0-9 10 ¶ 16 ¶ 26 1.1

10-19 55 4.6 148 11.8 203 8.3

20-29 41 5.0 178 20.9 219 13.2

30-39 25 3.5 85 11.9 110 7.7

40-49 20 2.6 71 9.4 91 6.0

50-59 10 ¶ 35 6.1 45 3.9

60-69 14 ¶ 17 ¶ 31 5.1

70 + 5 ¶ 19 ¶ 24 5.4

Total 180 3.1 569 9.8 749 6.5

Female Male Total

Table B-61. Alaska Unintentional Poisoning Death Rate†† by Race, Alcohol and Drugs Combined, 2002-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate††

AN/AI 256 25.3

Non-Native 649 10.9

Rate Ratio 2.3




Table B-62. Alaska Native Unintentional Poisoning Death Rate††, Type and Year, 1996-2011 Data Source: Alaska Bureau of Vital Statistics

n Rate †† n Rate ††

1996-1999 20 6.1 16 4.2**

2000-2003 41 10.5 17 4.8

2004-2007 42 11.0 23 5.6

2008-2011 72 16.4 87 21.1

Rate Ratio 2.7 5.0

Drugs Alcohol

APPENDIXES 115



n Rate §

Female 1,522 28.1

Male 598 11.4

Rate Ratio 2.5

Table B-64. Alaska Native Self-Inflicted Drug Poisoning Hospitalization Rate§ by Gender, 2002-2010 Data Source: Alaska Bureau of Vital Statistics


Table B-63. Self-Inflicted Drug Poisoning Hospitalization Rate§ by Race and Year, 1992-2010 Data Source: Alaska Bureau of Vital Statistics


n Rate § n Rate §

1992-1995 408 10.0 624 2.8

1996-1999 696 15.8 995 4.5

2000-2003 832 18.0 1,118 4.9

2004-2007 1,008 21.1 985 3.1

2008-2010 713 19.5 769 4.3

Rate Ratio 2.0 1.5

ANAI non-ANAI

Table B-65. Self-Inflicted Drug Poisoning Hospitalization Rate§ by Race and Year, 1992-2010 Data Source: Alaska Bureau of Vital Statistics


n Rate § n Rate §

1992-1995 228 5.7 1,899 53.9

1996-1999 550 12.9 2,273 59.7

2000-2003 901 20.1 2,755 68.1

2004-2007 1,106 23.8 2,888 67.4

2008-2010 931 19.4 2,563 57.4

Rate Ratio 3.4 1.1

ANAI non-ANAI

116 APPENDIXES


Appendix C. Injury Mechanisms with Corresponding ICD-9 and ICD-10 Codes

This table identifies the ICD-9 and -10 codes assigned to each injury mechanism as described in this report. In a few areas as noted the categorization differed between injury deaths and hospitalizations, based on injury frequency differences between the two data sets. ICD code assignments were applied to both data sets unless otherwise notated.

Data set involved Mechanism ICD-9 codes assigned ICD-10 codes assigned

(Hospitalizations) ATV E821.0-821.9

(Hospitalizations) Cut, Pierce E920

(Deaths) Drowning E830.0 - E830.9, E832.0 - E833.9, E910.0 - E910.9

V90.0 - V90.9, V92.0 - V92.9, W65.0 - W74.9

(Deaths) Excessive Cold E901.0 - E901.9 X31.0 - X31.9

Fall E880.0 - E881.9, E882, E883.0 - E886.9, E888.0 - E888.9

W00.0 - W19.9

Homicide, Assault

E960.0 - E960.9, E 961, E962.0 - E962.9, E 963, E964, E965.0 - E965.9, E966, E967.0 - E968.9, E969

X85.0 - X99.9, Y00.0 - Y09.9, Y87.1

Motor Vehicle E810.0 - E825.9, E929.0 V02.0 - V04.9, V09.0 - V09.9, V12.0 - 14.9, V19.0 - V85.9, V87.0 - V89.9, Y85.0 - Y85.9

(Hospitalizations) Natural and Environmental Factors E900-909, 928.0-928.2

(Deaths) Off-Road Vehicle E820.0-821.9 V86.0 - V86.9

Other and Unspecified All codes not listed in other categories

All codes not listed in other categories

(Hospitalizations) Other Vehicles E800-807, E826, E833-838, E840-845

Poisoning

E850.0 - E850.9, E851, E852.0 - E855.9, E856, E857, E858.0 - 866.9, E867, E868.0 - E869.9, E929.2

X40.0 - X49.9

Smoke, Fire, Flames

E890.0 - E891.9, E892, E893.0 - E893.9, E894, E895, E896, E897, E898.0 - E898.9, E899, E929.4

X00.0 - X09.9

(Hospitalizations) Snowmachine E820.0-820.9

(Hospitalizations) Struck by Person/Object E916-917

(Hospitalizations) Submersion and Suffocation E830.0 - E830.9, E832.0 - E832.9, E910.0 - E910.9, E911, E912, E913.0 - E913.9

Suicide, Self Harm E950.0 - E953.9, E954, E955.0 - E955.9, E956, E957.0 - E958.9, E959

X60.0 - X84.9, Y87.0

(Deaths) Threats to Breathing E911, E912, E913.0 - E913.9 W75.0 - W84.9

Undetermined Intent E980.0 - E983.9, E984, E985.0 - E985.9, E986, E987.0 - E988.9, E989

Y10.0 - X34.9, Y87.2

APPENDIXES 117


Appendix D. Access to Care Coding for Alaskan Communities

Community remoteness was defined using the following categories, based on data from the Alaska Rural Primary Care Facility Needs Assessment Project Final Report prepared for the Denali Commission, October, 2000. The codes classify communities by travel distance and type needed to reach a hospital.

Codes:

0 = In community with highest level of hospital care in Alaska (Anchorage) 1 = In community with a hospital with more limited service 2 = On the road system within 100 miles of a hospital 3 = Within 100 air/water miles of a hospital, or more than 100 miles by road 4 = More than 100 air/water miles from a hospital

Code Community Region Code Community Region

4 Adak Aleutians and Pribilofs 4 Atmautluak Yukon-Kuskokwim

4 Akhiok Kodiak 4 Atqasuk Arctic Slope

4 Akiachak Yukon-Kuskokwim 1 Barrow Arctic Slope

4 Akiak Yukon-Kuskokwim 4 Beaver Interior

4 Akutan Aleutians and Pribilofs 1 Bethel Yukon-Kuskokwim

4 Alakanuk Yukon-Kuskokwim 4 Bettles Interior

4 Alatna Interior 3 Big Delta Interior

3 Alcan Interior 2 Big Lake Anchorage/Mat-Su

2 Aleknagik Bristol Bay 4 Birch Creek Interior

4 Alexander Creek not census designated 4 Brevig Mission Norton Sound

4 Allakaket Interior 4 Buckland Northwest Arctic

4 Ambler Northwest Arctic 4 Deering Northwest Arctic

4 Anaktuvuk Pass Arctic Slope 3 Delta Junction Interior

2 Anchor Point Kenai Peninsula 1 Bristol Bay Bristol Bay

0 Anchorage Anchorage/Mat-Su 3 Dot Lake Interior

4 Anderson Interior 3 Dry Creek Interior

3 Andreafsky Yukon-Kuskokwim 4 Eagle Interior

4 Angoon Southeast 1 Eagle River/Chugiak Anchorage/Mat-Su

3 Aniak Yukon-Kuskokwim 4 Edna Bay Southeast

4 Anvik Interior 4 Eek Yukon-Kuskokwim

4 Arctic Village Interior 4 Egegik Bristol Bay

4 Atka Aleutians and Pribilofs 2 Eklutna Anchorage/Mat-Su

118 APPENDIXES


Appendix D. Access to Care Coding for Alaskan Communities (continued)


4 Ekwok Bristol Bay 3 Healy Interior

4 Elfin Cove Southeast 4 Healy Lake Interior

4 Elim Norton Sound 4 Hobart Bay Southeast

0 Elmendorf AFB Anchorage/Mat-Su 3 Hollis Southeast

4 Emmonak Yukon-Kuskokwim 4 Holy Cross Interior

2 Ester Interior 2 Butte Anchorage/Mat-Su

4 Evansville Interior 3 Cantwell Interior

2 Eyak Copper River/PWS 3 Central Interior

1 Fairbanks Interior 4 Chalkyitsik Interior

4 False Pass Aleutians and Pribilofs 4 Chase Anchorage/Mat-Su

3 Ferry Interior 4 Chefornak Yukon-Kuskokwim

4 Fort Yukon Interior 4 Chenega Bay Copper River/PWS

2 Fox Interior 4 Chevak Yukon-Kuskokwim

2 Fox River Kenai Peninsula 2 Chickaloon Anchorage/Mat-Su

2 Fritz Creek Kenai Peninsula 4 Chignik Bristol Bay

3 Gakona Copper River/PWS 4 Chignik Lagoon Bristol Bay

4 Galena Interior 4 Chignik Lake Bristol Bay

4 Gambell Norton Sound 3 Chiniak Kodiak

4 Game Creek Southeast 3 Chistochina Copper River/PWS

1 Girdwood Anchorage/Mat-Su 3 Chitina Copper River/PWS

3 Glennallen Copper River/PWS 4 Chuathbaluk Yukon-Kuskokwim

4 Golovin Norton Sound 3 Circle Interior

4 Goodnews Bay Yukon-Kuskokwim 3 Circle Hot Springs Interior

4 Grayling Interior 2 Clam Gulch Kenai Peninsula

3 Gulkana Copper River/PWS 4 Clark's Point Bristol Bay

3 Gustavus Southeast 3 Coffman Cove Southeast

3 Haines Southeast 2 Cohoe Kenai Peninsula

4 Halibut Cove Kenai Peninsula 4 Cold Bay Aleutians and Pribilofs

2 Happy Valley Kenai Peninsula 2 College Interior

3 Harding Lake Interior 2 Cooper Landing Kenai Peninsula

APPENDIXES 119




3 Copper Center Copper River/PWS 2 Kasilof Kenai Peninsula

3 Copperville Copper River/PWS 2 Kenai Kenai Peninsula

1 Cordova Copper River/PWS 3 Kenny Lake Copper River/PWS

4 Covenant Life Southeast 1 Ketchikan Southeast

3 Craig Southeast 4 Kiana Northwest Arctic

4 Crooked Creek Yukon-Kuskokwim 4 King Cove Aleutians and Pribilofs

2 Crown Point Kenai Peninsula 3 King Salmon Bristol Bay

4 Cube Cove Southeast 4 Kipnuk Yukon-Kuskokwim

1 Homer Kenai Peninsula 4 Kivalina Northwest Arctic

3 Hoonah Southeast 3 Klawock Southeast

4 Hooper Bay Yukon-Kuskokwim 3 Klukwan Southeast

2 Hope Kenai Peninsula 2 Knik Anchorage/Mat-Su

2 Houston Anchorage/Mat-Su 4 Kobuk Northwest Arctic

4 Hughes Interior 1 Kodiak Kodiak

4 Huslia Interior 4 Kokhanok Bristol Bay

3 Hydaburg Southeast 4 Koliganek Bristol Bay

4 Hyder Southeast 4 Kongiganak Yukon-Kuskokwim

4 Igiugig Bristol Bay 4 Kotlik Yukon-Kuskokwim

4 Iliamna Bristol Bay 1 Kotzebue Northwest Arctic

4 Ivanof Bay Bristol Bay 4 Koyuk Norton Sound

4 Jakolof Bay Kenai Peninsula 4 Koyukuk Interior

1 Juneau Southeast 4 Kupreanof Southeast

2 Kachemak Kenai Peninsula 4 Kwethluk Yukon-Kuskokwim

4 Kake Southeast 4 Kwigillingok Yukon-Kuskokwim

4 Kaktovik Arctic Slope 4 Lake Minchumina Interior

2 Kalifonsky Kenai Peninsula 4 Larsen Bay Kodiak

4 Kaltag Interior 2 Lazy Mountain Anchorage/Mat-Su

4 Karluk Kodiak 4 Levelock Bristol Bay

3 Kasaan Southeast 3 Lignite Interior

4 Kasigluk Yukon-Kuskokwim 4 Lime Village Yukon-Kuskokwim

120 APPENDIXES




4 Little Diomede Norton Sound 4 Nightmute Yukon-Kuskokwim

4 Lower Kalskag Yukon-Kuskokwim 2 Nikiski Kenai Peninsula

2 Lutak Southeast 2 Nikolaevsk Kenai Peninsula

3 Manley Hot Springs Interior 4 Nikolai Interior

4 Manokotak Bristol Bay 4 Nikolski Aleutians and Pribilofs

4 Marshall Yukon-Kuskokwim 2 Ninilchik Kenai Peninsula

2 McCarthy Copper River/PWS 4 Noatak Northwest Arctic

4 McGrath Interior 1 Nome Norton Sound

3 McKinley Park Interior 4 Nondalton Bristol Bay

2 Meadow Lakes Anchorage/Mat-Su 4 Noorvik Northwest Arctic

4 Mekoryuk Yukon-Kuskokwim 2 North Pole Interior

3 Mendeltna Copper River/PWS 3 Northway Interior

2 Mentasta Lake Copper River/PWS 3 Northway Junction Interior

3 Metlakatla Southeast 4 Nuiqsut Arctic Slope

4 Meyers Chuck Southeast 4 Nulato Interior

4 Minto Interior 4 Nunam Iqua Yukon-Kuskokwim

2 Moose Creek Interior 4 Nunapitchuk Yukon-Kuskokwim

2 Moose Pass Kenai Peninsula 4 Old Harbor Kodiak

3 Mosquito Lake Southeast 4 Oscarville Yukon-Kuskokwim

4 Mountain Village Yukon-Kuskokwim 4 Ouzinkie Kodiak

3 Naknek Bristol Bay 1 Palmer Anchorage/Mat-Su

4 Nanwalek Kenai Peninsula 3 Paxson Copper River/PWS

4 Napakiak Yukon-Kuskokwim 4 Pedro Bay Bristol Bay

4 Napaskiak Yukon-Kuskokwim 3 Pelican Southeast

3 Naukati Bay Southeast 4 Perryville Bristol Bay

4 Nelson Lagoon Aleutians and Pribilofs 1 Petersburg Southeast

2 Nenana Interior 4 Pilot Point Bristol Bay

4 New Stuyahok Bristol Bay 4 Pilot Station Yukon-Kuskokwim

4 Newhalen Bristol Bay 4 Pitka's Point Yukon-Kuskokwim

4 Newtok Yukon-Kuskokwim 3 Platinum Yukon-Kuskokwim

APPENDIXES 121




2 Pleasant Valley Interior 4 Shageluk Interior

4 Point Baker Southeast 4 Shaktoolik Norton Sound

4 Point Hope Arctic Slope 4 Shishmaref Norton Sound

4 Point Lay Arctic Slope 4 Shungnak Northwest Arctic

4 Port Alexander Southeast 1 Sitka Southeast

4 Port Alsworth Bristol Bay 3 Skagway Southeast

4 Port Clarence Norton Sound 4 Skwentna Anchorage/Mat-Su

4 Port Graham Kenai Peninsula 3 Slana Copper River/PWS

4 Port Heiden Bristol Bay 4 Sleetmute Yukon-Kuskokwim

4 Port Lions Kodiak 1 Soldatna Kenai Peninsula

4 Port Protection Southeast 4 South Naknek Bristol Bay

2 Primrose Kenai Peninsula 4 Stebbins Norton Sound

4 Prudhoe Bay Arctic Slope 2 Sterling Kenai Peninsula

4 Quinhagak Yukon-Kuskokwim 4 Stevens Village Interior

4 Rampart Interior 4 Stony River Yukon-Kuskokwim

4 Red Devil Yukon-Kuskokwim 2 Sutton Anchorage/Mat-Su

2 Ridgeway Kenai Peninsula 4 Takotna Interior

4 Ruby Interior 2 Talkeetna Anchorage/Mat-Su

4 Russian Mission Yukon-Kuskokwim 3 Tanacross Interior

4 Saint George Aleutians and Pribilofs 4 Tanana Interior

4 Saint Mary's Yukon-Kuskokwim 4 Tatitlek Copper River/PWS

3 Saint Michael Norton Sound 4 Tazlina Copper River/PWS

4 Saint Paul Island Aleutians and Pribilofs 3 Teller Norton Sound

2 Salamatof Kenai Peninsula 4 Tenakee Springs Southeast

2 Salcha Interior 4 Tetlin Interior

4 Sand Point Aleutians and Pribilofs 3 Thorne Bay Southeast

4 Savoonga Norton Sound 3 Togiak Bristol Bay

2 Saxman Southeast 3 Tok Interior

4 Scammon Bay Yukon-Kuskokwim 4 Toksook Bay Yukon-Kuskokwim

4 Selawik Northwest Arctic 3 Tonsina Copper River/PWS

3 Seldovia Kenai Peninsula 2 Trapper Creek Anchorage/Mat-Su

1 Seward Kenai Peninsula 4 Tuluksak Yukon-Kuskokwim

122 APPENDIXES




4 Tuntutuliak Yukon-Kuskokwim 4 Wales Norton Sound

4 Tununak Yukon-Kuskokwim 1 Wasilla Anchorage/Mat-Su

4 Twin Hills Bristol Bay 3 Whale Pass Southeast

2 Two Rivers Interior 4 White Mountain Norton Sound

4 Tyonek Kenai Peninsula 3 Whitestone Logging Camp Southeast

4 Unalakleet Norton Sound 3 Whittier Copper River/PWS

4 Unalaska Aleutians and Pribilofs 2 Willow Anchorage/Mat-Su

4 Upper Kalskag Yukon-Kuskokwim 4 Wiseman Interior

1 Valdez Copper River/PWS 2 Womens Bay Kodiak

4 Venetie Interior 1 Wrangell Southeast

4 Wainwright Arctic Slope 4 Yakutat Southeast

Ph

oto

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y H

. Str

aye

r

APPENDIXES 123


FIGURES

Figure 1. Leading Causes of Death by Age Group, Alaska Native People, 2001-2010 ........................... 7

Figure 2. Leading Causes of Injury Death by Region, Alaska Native People, 2002-2011 ....................... 8

Figure 3. Leading Causes of Injury Death by Age, Alaska Native People, 2002-2011 ............................ 8

Figure 4. Leading Causes of Injury Death, Alaska Native Females, All Regions, 2002-2011 .................. 9

Figure 5. Leading Causes of Injury Death Alaska Native Males, All Regions, 2002-2011 ...................... 9

Figure 6. Intentional Injury Death Rate †† by Region, Alaska Native People, 2002-2011 ..................... 10

Figure 7. Intentional Injury Death Rate †† by Gender, Race and Year, 1992-2011 ............................... 10

Figure 8. Intentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011 ...................... 11

Figure 9. Unintentional Injury Death Rate †† by Region, Alaska Native People, 2002-2011 ................ 12

Figure 10. Unintentional Injury Death Rate †† by Gender, Race and Year, 1992-2011 .......................... 12

Figure 11. Unintentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011 .................. 13

Figure 12. Suicide Death Rate †† by Region, Alaska Native People, 2002-2011 ..................................... 14

Figure 13. Suicide Death Rate †† by Gender, Race and Year, 1992-2011 ............................................... 14

Figure 14. Suicide Death by Type, Alaska Native People, All Ages, 2002-2011 ....................................... 15

Figure 15. Poisoning Death Rate †† by Region, Alaska Native People, 2002-2011 ................................. 16

Figure 16. Poisoning Death Rate †† by Gender, Race and Year, 1992-2011 ........................................... 16

Figure 17. Poisoning Death by Type, Alaska Native People, All Ages, 2002-2011 ................................... 17

Figure 18. Drowning Death Rate †† by Region, Alaska Native People, 2002-2011 ................................. 18

Figure 19. Drowning Death Rate †† by Gender, Race and Year, 1992-2011 ........................................... 18

Figure 20. Drowning Death by Type, Alaska Native People, All Ages, 2002-2011 ................................... 19

Figure 21. Motor Vehicle Death Rate †† by Region, Alaska Native People, 2002-2011 ......................... 20

Figure 22. Motor Vehicle Death Rate †† by Gender, Race and Year, 1992-2011 .................................... 20

Figure 23. Motor Vehicle Death by Type, Alaska Native People, All Ages, 2002-2011 ........................... 21

Figure 24. Homicide Death Rate †† by Region, Alaska Native People, 2002-2011 ................................. 22

Figure 25. Homicide Death Rate †† by Gender, Race and Year, 1992-2011 ........................................... 22

Figure 26. Homicide Death by Type, Alaska Native People, All Ages, 2002-2011 ................................... 23

Figure 27. Leading Causes of Injury Hospitalization by Region, All Alaska Native People, 2002-2011* . 26

Figure 28. Leading Causes of Injury Hospitalization by Age Group, All Alaska Native People, 2002-2011 .................................................................................................................. 26

Figure 29. Leading Causes of Injury Hospitalization, Alaska Native Males, All Regions, 2002-2011 ....... 27

Figure 30. Leading Causes of Injury Hospitalization, Alaska Native Females, All Regions, 2002-2011 ... 27

Figure 31. Intentional Injury Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ......... 28

Figure 32. Intentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ................... 28

Figure 33. Intentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ........ 29

Appendix E. Figures and Tables

124 APPENDIXES


Figure 34. Unintentional Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ............... 30

Figure 35. Unintentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ............... 30

Figure 36. Unintentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ... 31

Figure 37. Falls Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 .............................. 32

Figure 38. Falls Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ........................................ 32

Figure 39. Falls Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ............................. 33

Figure 40. Suicide Attempt or Self Harm Hospitalization Rate§ by Region, Alaska Native People, 2002-2010 .................................................................................................................. 34

Figure 41. Suicide Attempt or Self Harm Hospitalization Rate§ by Gender, Race and Year, 1992-2010 ...................................................................................................................... 34

Figure 42. Suicide Attempt or Self Harm Hospitalization by Type, Alaska Native People, All Ages, 2002-2010 ................................................................................................................ 35

Figure 43. Assault Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ......................... 36

Figure 44. Assault Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ................................... 36

Figure 45. Assault Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ........................ 37

Figure 46. Motor Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 .............. 38

Figure 47. Motor Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ........................ 38

Figure 48. Motor Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ............. 39

Figure 49. All-Terrain Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ....... 40

Figure 50. All-Terrain Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ................. 40

Figure 51. All-Terrain Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ...... 41

Figure 52. Snowmachine Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 .............. 42

Figure 53. Snowmachine Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ........................ 42

Figure 54. Snowmachine Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ............. 43

Figure 55. Alaska Native Unintentional Poisoning Death Rate, Type and Year, 1996-2011 ................... 71

Figure 56. Self-Inflicted Drug Poisoning Hospitalization Rate, Race and Year, 1992-2010 ..................... 73

Figure 57. Rate of Hospitalizations Associated with Drugs or Alcohol by Race, Alaska, 1992-2011 ....... 75

TABLES

Table 1. Regions by Tribal Health Organizations and Census Areas..................................................... 45

Table 2. Leading Causes of Aleutians and Pribilofs Injury Hospitalizations, 1992-2011 ...................... 46

Table 3. Leading Causes of Aleutians and Pribilofs Injury Deaths, 1992-2011 ..................................... 47

Table 4. Leading Causes of Anchorage and Matanuska-Susitna Injury Hospitalizations, 1992-2011 .. 48

Table 5. Leading Causes of Anchorage and Matanuska-Susitna Injury Deaths, 1992-2011 ................ 49

Table 6. Leading Causes of Arctic Slope Injury Hospitalizations, 1992-2011 ....................................... 50

Table 7. Leading Causes of Arctic Slope Injury Deaths, 1992-2011 ...................................................... 51

Table 8. Leading Causes of Bristol Bay Injury Hospitalizations, 1992-2011 ......................................... 52

Appendix E. Figures and Tables (continued)

APPENDIXES 125


Table 9. Leading Causes of Bristol Bay Injury Deaths, 1992-2011 ........................................................ 53

Table 10. Leading Causes of Copper River/Prince William Sound Injury

Hospitalizations, 1992-2011 ................................................................................................... 54

Table 11. Leading Causes of Copper River/Prince William Sound Injury Deaths, 1992-2011 ................ 55

Table 12. Leading Causes of Interior Injury Hospitalization, 1992-2011 ................................................ 56

Table 13. Leading Causes of Interior Injury Deaths, 1992-2011............................................................. 57

Table 14. Leading Causes of Kenai Peninsula Injury Hospitalization, 1992-2011 .................................. 58

Table 15. Leading Causes of Kenai Peninsula Injury Deaths, 1992-2011 ............................................... 59

Table 16. Leading Causes of Kodiak Injury Hospitalization, 1992-2011 ................................................. 60

Table 17. Leading Causes of Kodiak Injury Deaths, 1992-2011 .............................................................. 61

Table 18. Leading Causes of Northwest Arctic Injury Hospitalization, 1992-2011 ................................ 62

Table 19. Leading Causes of Northwest Arctic Injury Deaths, 1992-2011 ............................................. 63

Table 20. Leading Causes of Norton Sound Injury Hospitalization, 1992-2011 ..................................... 64

Table 21. Leading Causes of Norton Sound Injury Deaths, 1992-2011 .................................................. 65

Table 22. Leading Causes of Southeast Injury Hospitalization, 1992-2011 ............................................ 66

Table 23. Leading Causes of Southeast Injury Deaths, 1992-2011......................................................... 67

Table 24. Leading Causes of Yukon-Kuskokwim Injury Hospitalization, 1992-2011 .............................. 68

Table 25. Leading Causes of Yukon-Kuskokwim Injury Deaths, 1992-2011 ........................................... 69

Table 26 Frequency of Unintentional Poisoning Hospitalization among Alaska Native Children by

Poison Type (N = 549) - Alaska, 2002-2011 ............................................................................ 72

Table 27. Alaska Native Self-Inflicted Drug Poisoning Hospitalization Rates, 2002-2010 ...................... 73

Table 28. Alaska Native Hospitalizations with Known or Suspected Alcohol or Drug Involvement by

Mechanism, 2002-2011 .......................................................................................................... 74

Table 29. Alaska Native Hospitalizations with Alcohol or Drug Involvement by Region, 2002-2011 .... 75

Table 30. Distribution of Population in Alaska by Access to Care Category and Race, 2010 ................. 76

Table 31. Alaska Native Injury Hospitalizations, Access to Care by Mechanism, 2002-2011 ................ 77

Table 32. Alaska Native Injury Deaths, Access to Care by Mechanism, 2002-2011 ............................... 77

DATA TABLES

Table B-1. Intentional Injury Death Rate†† by Region, Alaska Native People, 2002-2011 ..................... 84

Table B-2. Intentional Injury Death Rate†† by Gender, Race and Year, 1992-2011................................ 85

Table B-3. Intentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011 ...................... 85

Table B-4. Intentional Injury Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 .................................................................................................................. 86

Table B-5. Unintentional Injury Death Rate†† by Region, Alaska Native People, 2002-2011 ................. 86

Table B-6. Unintentional Injury Death Rate†† by Gender, Race and Year, 1992-2011 ........................... 87

Table B-7. Unintentional Injury Death by Type, Alaska Native People, All Ages, 2002-2011 .................. 87

Table B-8. Unintentional Injury Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 .................................................................................................................. 88


126 APPENDIXES


Table B-9. Suicide Death Rate†† by Region, Alaska Native People, 2002-2011 .................................... 88

Table B-10. Suicide Death Rate†† by Gender, Race and Year, 1992-2011 .............................................. 89

Table B-11. Suicide Death by Type, Alaska Native People, All Ages, 2002-2011 ..................................... 89

Table B-12. Suicide Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 .............. 90

Table B-13. Poisoning Death Rate†† by Region, Alaska Native People, 2002-2011 ................................ 90

Table B-14. Poisoning Death Rate†† by Gender, Race and Year, 1992-2011 .......................................... 91

Table B-15. Poisoning Death by Type, Alaska Native People, All Ages, 2002-2011 ................................. 91

Table B-16. Poisoning Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 ......... 92

Table B-17. Drowning Death Rate†† by Region, Alaska Native People, 2002-2011 ................................ 92

Table B-18. Drowning Death Rate†† by Gender, Race and Year, 1992-2011 .......................................... 93

Table B-19. Drowning Death by Type, Alaska Native People, All Ages, 2002-2011 ................................. 93

Table B-20. Drowning Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 ......... 94

Table B-21. Motor Vehicle Death Rate†† by Region, Alaska Native People, 2002-2011 ........................ 94

Table B-22. Motor Vehicle Death Rate†† by Gender, Race and Year, 1992-2011 .................................. 95

Table B-23. Motor Vehicle Death by Type, Alaska Native People, All Ages, 2002-2011 ......................... 95

Table B-24. Motor Vehicle Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 .. 96

Table B-25. Homicide Death Rate†† by Region, Alaska Native People, 2002-2011 ................................ 96

Table B-26. Homicide Death Rate†† by Gender, Race and Year, 1992-2011 .......................................... 97

Table B-27. Homicide Death by Type, Alaska Native People, All Ages, 2002-2011 ................................. 97

Table B-28. Homicide Death Rate††, Gender and Age Group, Alaska Native People, 2002-2011 .......... 98

Table B-29. Intentional Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ................. 98

Table B-30. Intentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ................. 99

Table B-31. Intentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ...... 99

Table B-32. Intentional Injury Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 ................................................................................................................ 100

Table B-33. Unintentional Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ............. 100

Table B-34. Unintentional Injury Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ............. 101

Table B-35. Unintentional Injury Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 . 101

Table B-36. Unintentional Injury Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 ................................................................................................................ 102

Table B-37. Falls Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ............................ 102

Table B-38. Falls Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ...................................... 103

Table B-39. Falls Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ........................... 103

Table B-40. Falls Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 ...... 104


APPENDIXES 127


Table B-41. Suicide Attempt or Self Harm Hospitalization Rate§ by Region, Alaska Native People, 2002-2010 ................................................................................................................ 104

Table B-42. Suicide Attempt or Self Harm Hospitalization Rate§ by Gender, Race and Year, 1992-2010 .................................................................................................................... 105

Table B-43. Suicide Attempt or Self Harm Hospitalization by Type, Alaska Native People, All Ages, 2002-2010 .............................................................................................................. 105

Table B-44. Suicide Attempt or Self Harm Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2010 ......................................................................................... 106

Table B-45. Assault Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ....................... 106

Table B-46. Assault Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ................................. 107

Table B-47. Assault Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ...................... 107

Table B-48. Assault Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 . 108

Table B-49. Motor Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ............ 108

Table B-50. Motor Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ...................... 109

Table B-51. Motor Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ........... 109

Table B-52. Motor Vehicle Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 ................................................................................................................ 110

Table B-53. All-Terrain Vehicle Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ..... 110

Table B-54. All-Terrain Vehicle Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ............... 111

Table B-55. All-Terrain Vehicle Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 .... 111

Table B-56. All-Terrain Vehicle Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 ................................................................................................................ 112

Table B-57. Snowmachine Hospitalization Rate§ by Region, Alaska Native People, 2002-2011 ............ 112

Table B-58. Snowmachine Hospitalization Rate§ by Gender, Race and Year, 1992-2011 ...................... 113

Table B-59. Snowmachine Hospitalization by Type, Alaska Native People, All Ages, 2002-2011 ........... 113

Table B-60. Snowmachine Hospitalization Rate§, Gender and Age Group, Alaska Native People, 2002-2011 ................................................................................................................ 114

Table B-61. Alaska Unintentional Poisoning Death Rate†† by Race, Alcohol and Drugs Combined, 2002-2011 .......................................................................................................... 114

Table B-62. Alaska Native Unintentional Poisoning Death Rate††, Type and Year, 1996-2011 ............... 114

Table B-63. Self-Inflicted Drug Poisoning Hospitalization Rate§ by Race and Year, 1992-2010 .............. 115

Table B-64. Alaska Native Self-Inflicted Drug Poisoning Hospitalization Rate§ by Gender, 2002-2010 .. 115

Table B-65. Self-Inflicted Drug Poisoning Hospitalization Rate§ by Race and Year, 1992-2010 .............. 115


128 APPENDIXES


Age-adjusted rate

The application of age-specific rates in a population of interest to a standardized age distribution in order to eliminate differences in observed rates that result from age differences in population composition. This adjustment is usually done when comparing two or more populations at one point in time or one population at two or more points in time.


Intentional injuries are purposeful or deliberate harm caused by one person to themselves or another person. The most common categories of intentional injures are suicide/suicide attempt, homicide, assault and abuse.

Rate ratio

A comparison of two rates to show how many times larger or smaller one is compared to the other. Generally, the rate in the population of interest is compared with that of a standard population (for which data are available and published). A rate ratio of less than one means that the rate in the population of interest is lower than that of the comparison population. For example, a rate ratio of 0.8 means that the rate in the population of interest is 20 percent lower than in the comparison population. Conversely, a rate ratio of 1.2 means that the rate in the population of interest is 20 percent higher than in the comparison population.

Unadjusted rate

An estimate of the proportion of a population that experiences the event of interest (e.g. assault hospitalization rate) during a specified period. It is calculated by dividing the number of observations by the appropriate population multiplied by 100,000 (or other appropriate multiplier). When interpreting these rates, remember that rates may be affected by differences in population structures between areas. For example, if an area had a high concentration of older people, this alone would result in higher unadjusted death rates for many causes.


Unintentional injuries are all injuries where the harmful outcome was not intended or planned, or was not caused on purpose. The term “accident” is not used in this report because it implies that the injury cannot be prevented.

Appendix F. Glossary of Terms

APPENDIXES 129


Errata corrected October 7, 2014

Falls, Injury Hospitalizations, page 32

Figure 38. Falls Hospitalization Rate by Gender, Race, and Year 1992-2011: Alaska Native and Non-

Native male and female data were reversed. For example, rates labeled “AK AN/AI Male” are for AN/AI

females.

Suicide Attempt or Self Harm, Injury Hospitalizations, page 34

Figure 41. Suicide Attempt or Self Harm Hospitalization Rate by Gender, Race, and Year 1992-2010:

Alaska Native and Non-Native male and female data were reversed. For example, rates labeled “AK AN/

AI Male” are for AN/AI females.

Appendix B. Data Tables

Page 85 Table B-2, Intentional Injury Death Rate by Gender, Race and Year, 1992-2011: Alaska Non-

Native n values for male and female are reversed. All rates are listed correctly.

Page 95 Table B-22. Motor Vehicle Death Rate by Gender, Race and Year, 1992-2011: Header is missing

for Alaska Native data (Alaska Native Male, Female, Total). Alaska Non-Native Total n values and rates

are incorrect. Correct values are:

Page 103 Table B-38, Falls Hospitalization Rate by Gender, Race and Year, 1992-2011: Alaska Native

and Non-Native male and female data were reversed. For example, rates labeled “AK AN/AI Male” are

for AN/AI females. All n values are listed correctly.

Page 105 Table B-42, Suicide Attempt or Self Harm Hospitalization Rate by Gender, Race and Year,

1992-2010: Alaska Native and Non-Native male and female data were reversed. For example, rates

labeled “AK AN/AI Male” are for AN/AI females. All n values are listed correctly.

Page 109 Table B-50, Motor Vehicle Hospitalization Rate by Gender, Race and Year, 1992-2011: Alaska

Non-Native Total n values and rates are incorrect. Correct values are:

Alaska Non-Native Total

n Rate

1992-1995 330 19.2 1996-1999 245 13.0 2000-2003 315 16.5 2004-2007 275 13.1 2008-2011 202 8.7

Alaska Non-Native Total

n Rate

1992-1995 2,063 11.0 1996-1999 1,967 10.1 2000-2003 2,143 10.8 2004-2007 1,784 8.3 2008-2011 1,468 6.4

130 APPENDIXES


Errata corrected May 5, 2014

Executive Summary, page 2

Injury Deaths 2nd bullet: corrected percent decrease in rate values. Drowning (from 56.6% to 56.5%),

motor vehicle (from 45.7% to 45.6%), homicide (from 38.3% to 37.9%) and suicide (from 14.3% to

14.4%).

Injury Hospitalizations 1st bullet: corrected names of 3rd leading cause (from motor vehicle crashes to

assaults) and percent of injury hospitalizations the three leading causes comprised (from 71.6% to

60.4%).

Suicide, Injury Deaths, page 15

Summary, 3rd bullet: corrected percentage firearms were of means of suicide deaths (from 57.9% to

58.0%).

Drowning, Injury Deaths, page 19

Summary, 3rd bullet: corrected percentage being or falling into natural water were of circumstances for

drowning deaths (from 48.3% to 48.5%).

Suicide Attempt or Self Harm, Injury Hospitalizations, page 35

Summary, 1st bullet: corrected percentage suicide attempt and self harm were of all injury

hospitalizations (from 19.5% to 18.0%) and corrected the number of all injury hospitalizations (from

14,914 to 16,141).

All-Terrain Vehicle, Injury Hospitalizations, page 41

Summary, 2nd bullet: reversed rates to associate them with the correct time periods (from “5.9 and 5.2”

to “5.2 and 5.9”).

Summary box, 3rd bullet: corrected percentage ATV drivers were of all ATV-related hospitalizations

(from 61.2% to 61.1%).

APPENDIXES 131


Errata corrected April 28, 2014

Inside front cover

Behavioral Health Department’s Substance Abuse Prevention Initiative added as a funder for the report.

Acknowledgements, page i

Suggested Citation: Added suggested citation before Acknowledgements.

Leading Causes of Injury Hospitalization, pages 26-27

Figures 27 – 30: Changed Data Source to Alaska Trauma Registry

Special Topics, page 71

Drug and Alcohol Poisonings: Added information on national percentages of unintentional poisoning

causes.

Alaska Native Tribal Health Consortium

Injury Prevention Program and Alaska Native Epidemiology Center

3900 Ambassador Drive, Suite 401

Anchorage AK 99508

[email protected]

Website: http://anthctoday.org/community/prevention.html

and http://www.anthctoday.org/epicenter

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